Montefiore Medical Center/Renal Division, Albert Einstein College of Medicine, Bronx, NY 10467, USA.
Adv Chronic Kidney Dis. 2013 Sep;20(5):390-5. doi: 10.1053/j.ackd.2013.05.004.
In most experimental models of CKD, male animals progress more rapidly than females. Modulation of the hormonal milieu can replicate the effects of gender on the course of kidney disease. These observations suggest that sex hormones per se may be important determinants of the greater susceptibility of males to progressive kidney injury. The predominance of data in humans suggests that the course of nondiabetic kidney disease is more aggressive in men than women. Male gender is arguably also a risk factor for progression of diabetic nephropathy. Sex hormones directly or indirectly affect many cellular processes by modulating the synthesis of various cytokines, growth factors, and vasoactive agents. In particular, estrogen acts in a receptor-dependent mechanism to regulate genes involved in extracellular matrix metabolism. Estrogen has profound effects on transforming growth factor-β signal transduction and on the renin-angiotensin system. These effects may contribute to alterations in kidney hemodynamics and affect kidney disease progression. Selective estrogen receptor modulators, agents that mimic many of the beneficial effects of estrogen without reproducing estrogen's deleterious effects on reproductive tissue, ameliorate the course of kidney disease in animal models and in postmenopausal women.
在大多数慢性肾脏病的实验模型中，雄性动物的进展速度快于雌性动物。激素环境的调节可以复制性别对肾脏疾病进程的影响。这些观察结果表明，性激素本身可能是男性对进行性肾损伤更易感性的重要决定因素。在人类中占主导地位的数据表明，非糖尿病性肾病的病程在男性中比女性更具侵袭性。男性性别也可以说是糖尿病肾病进展的一个危险因素。性激素通过调节各种细胞因子、生长因子和血管活性物质的合成，直接或间接地影响许多细胞过程。特别是，雌激素通过受体依赖性机制调节细胞外基质代谢相关基因。雌激素对转化生长因子-β信号转导和肾素-血管紧张素系统有深远的影响。这些影响可能导致肾脏血液动力学的改变，并影响肾脏疾病的进展。选择性雌激素受体调节剂是一种能够模拟雌激素的许多有益作用而不重现雌激素对生殖组织的有害作用的药物，它可以改善动物模型和绝经后妇女的肾脏疾病进程。
