Neuzillet Y, Thuret R, Kleinclauss F, Timsit M-O
Service d'urologie et de transplantation rénale, hôpital Foch, 40, rue Worth, 92150 Suresnes, France; Université de Versailles, Saint-Quentin-en-Yvelines, France.
Service d'urologie et de transplantation rénale, hôpital Lapeyronie, Montpellier, France; Université de Montpellier, Montpellier, France.
Prog Urol. 2016 Nov;26(15):1088-1093. doi: 10.1016/j.purol.2016.08.013. Epub 2016 Sep 16.
To describe the state of the art of current knowledge regarding gonadal consequences of end-stage chronic kidney disease (CKD) and renal transplantation.
A systematic review of the literature search was performed from the databases Medline (NLM, Pubmed) and Embase, focused on the following keywords: "chronic kidney disease"; "chronic renal failure"; "hypogonadism"; "kidney transplantation"; "testicular dysfunction"; "testosterone". Publications obtained were selected based on methodology, language, date of publication (last 10 years) and relevance. Prospective and retrospective studies, in English or French, review articles; meta-analysis and guidelines were selected and analyzed. This search found 383 articles. After reading titles and abstracts, 51 were included in the text, based on their relevance.
The prevalence of hypogonadism in CKD is reported between 24 % and 66 %, and decreases partially after renal transplantation. This is a hypogonadotropic hypogonadism whose pathophysiology is multifactorial, involving mainly a primitive testicular deficit, a hypothalamic-pituitary dysregulation, and an hyperprolactinemia. The consequences of this hypogonadism are not only sexual but also contribute to anemia, sarcopenia, atherosclerosis, and potentially in the progression of CKD. Hypogonadism is an independent risk factor for mortality in CKD patients.
CKD is frequently associated with an hypogonadism whose correction is validated only in the setting of erectile dysfunction treatment. The other benefits of the correction of hypogonadism in the CKD patients, including overall survival, needs to be evaluated.
描述关于终末期慢性肾脏病（CKD）和肾移植的性腺后果的当前知识现状。
从Medline（美国国立医学图书馆，PubMed）和Embase数据库进行文献检索的系统综述，重点关注以下关键词：“慢性肾脏病”；“慢性肾衰竭”；“性腺功能减退”；“肾移植”；“睾丸功能障碍”；“睾酮”。根据方法、语言、出版日期（最近10年）和相关性选择获得的出版物。选择并分析了英文或法文的前瞻性和回顾性研究、综述文章、荟萃分析和指南。该检索共找到383篇文章。阅读标题和摘要后，根据相关性将51篇纳入正文。
CKD中性腺功能减退的患病率报告为24%至66%，肾移植后部分降低。这是一种低促性腺激素性性腺功能减退，其病理生理学是多因素的，主要涉及原发性睾丸缺陷、下丘脑 - 垂体调节异常和高催乳素血症。这种性腺功能减退的后果不仅涉及性功能，还会导致贫血、肌肉减少症、动脉粥样硬化，并可能促进CKD的进展。性腺功能减退是CKD患者死亡的独立危险因素。
CKD常伴有性腺功能减退，仅在勃起功能障碍治疗方面，其纠正已得到验证。CKD患者性腺功能减退纠正的其他益处，包括总体生存率，需要进行评估。
