Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy.
Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy.
Int J Mol Sci. 2021 May 28;22(11):5808. doi: 10.3390/ijms22115808.
Diabetic kidney disease (DKD) is one of the most serious complications of both type 1 (T1DM) and type 2 diabetes mellitus (T2DM). Current guidelines recommend a personalized approach in order to reduce the burden of DM and its complications. Recognizing sex and gender- differences in medicine is considered one of the first steps toward personalized medicine, but the gender issue in DM has been scarcely explored so far. Gender differences have been reported in the incidence and the prevalence of DKD, in its phenotypes and clinical manifestations, as well as in several risk factors, with a different impact in the two genders. Hormonal factors, especially estrogen loss, play a significant role in explaining these differences. Additionally, the impact of sex chromosomes as well as the influence of gene-sex interactions with several susceptibility genes for DKD have been investigated. In spite of the increasing evidence that sex and gender should be included in the evaluation of DKD, several open issues remain uncovered, including the potentially different effects of newly recommended drugs, such as SGLT2i and GLP1Ras. This narrative review explored current evidence on sex/gender differences in DKD, taking into account hormonal, genetic and clinical factors.
糖尿病肾病（DKD）是 1 型（T1DM）和 2 型糖尿病（T2DM）的最严重并发症之一。目前的指南建议采用个性化方法，以减轻 DM 及其并发症的负担。认识到医学中的性别差异被认为是迈向个性化医学的第一步，但迄今为止，DM 中的性别问题几乎没有得到探索。DKD 的发病率和患病率、表型和临床表现以及几个危险因素中都存在性别差异，对两性的影响不同。激素因素，尤其是雌激素缺乏，在解释这些差异方面起着重要作用。此外，还研究了性染色体的影响以及几个 DKD 易感基因与基因性别相互作用的影响。尽管越来越多的证据表明，在评估 DKD 时应考虑到性别差异，但仍有一些悬而未决的问题，包括新推荐药物（如 SGLT2i 和 GLP1Ras）的潜在不同影响。本综述探讨了 DKD 中性别差异的当前证据，考虑了激素、遗传和临床因素。
