Kaka Nirja, Sethi Yashendra, Patel Neil, Kaiwan Okashah, Al-Inaya Yana, Manchanda Kshitij, Uniyal Nidhi
GMERS Medical College, Himmatnagar, Gujarat 382007, India.
Department of Medicine, Government Doon Medical College, Dehradun, Uttarakhand, India.
Dis Mon. 2022 Dec;68(12):101466. doi: 10.1016/j.disamonth.2022.101466. Epub 2022 Aug 12.
Chronic Kidney Disease (CKD) shows a wide range of renal abnormalities including the excretory, metabolic, endocrine, and homeostatic function of the kidney. The prognostic impact of the 'endocrine manifestations' which are often overlooked by clinicians cannot be overstated.
A systematic review was attempted to provide a comprehensive overview of all endocrine abnormalities of CKD and their evolving principles of management, searching databases of PubMed, Embase, and Scopus and covering the literature between 2002 and 2022.
The endocrine derangements in CKD can be attributed to a myriad of pathologic processes, in particular decreased clearance, impaired endogenous hormone production, uremia-induced cellular dysfunction, and activation of systemic inflammatory pathways. The major disorders include anemia, hyperprolactinemia, insulin resistance, reproductive hormone deficiency, thyroid hormone deficiency, and serum FGF (Fibroblast Growth Factor) alteration. Long-term effects of CKD also include malnutrition and increased cardiovascular risk. The recent times have unveiled their detailed pathogenesis and have seen an evolution in the principles of management which necessitates a revision of current guidelines.
Increased advertence regarding the pathology, impact, and management of these endocrine derangements can help in reducing morbidity as well as mortality in the CKD patients by allowing prompt individualized treatment. Moreover, with timely and appropriate intervention, a long-term reduction in complications, as well as an enhanced quality of life, can be achieved in patients with CKD.
慢性肾脏病（CKD）表现出广泛的肾脏异常，包括肾脏的排泄、代谢、内分泌和内环境稳定功能。临床医生常常忽视的“内分泌表现”对预后的影响再怎么强调都不为过。
试图进行一项系统综述，以全面概述CKD的所有内分泌异常及其不断演变的管理原则，检索了PubMed、Embase和Scopus数据库，并涵盖了2002年至2022年的文献。
CKD中的内分泌紊乱可归因于多种病理过程，特别是清除率降低、内源性激素产生受损、尿毒症诱导的细胞功能障碍以及全身炎症途径的激活。主要疾病包括贫血、高催乳素血症、胰岛素抵抗、生殖激素缺乏、甲状腺激素缺乏和血清成纤维细胞生长因子（FGF）改变。CKD的长期影响还包括营养不良和心血管风险增加。近年来已经揭示了它们详细的发病机制，并且在管理原则方面有了演变，这就需要修订当前的指南。
提高对这些内分泌紊乱的病理、影响和管理的关注度，通过及时进行个体化治疗，有助于降低CKD患者的发病率和死亡率。此外，通过及时和适当的干预，可以实现CKD患者并发症的长期减少以及生活质量的提高。
