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[通过传统方程估算跨性别者肾小球滤过率的争议:通过病例报告进行讨论]

[Controversy in estimating glomerular filtration rate through traditional equations in transgender people: discussion through a case report].

作者信息

Sarmento Guedes Ingrid, Costa Vasconcelos Luiz Valério, Lázaro de Oliveira Ana Paula Pires, De Francesco Daher Elizabeth, Bezerra da Silva Junior Geraldo

机构信息

Corso di Medicina, Centro di Scienze della Salute, Universidade de Fortaleza. Fortaleza, Ceará, Brasile.

Dipartimento di Medicina Clinica, Facoltá di Medicina, Universidade Federal do Ceará. Fortaleza, Ceará, Brasile.

出版信息

G Ital Nefrol. 2022 Aug 29;39(4):2022-vol4.

Abstract

Chronic kidney disease (CKD) and the number of transgender people is on the rise. Hormone replacement therapy may be associated with the development of adverse effects, including kidney disease. To report the case of a transgender patient using hormone therapy who developed CKD. Male transgender patient, 28 years old, using testosterone cypionate every 15 days, without any comorbidity. Evolved with hypertensive peaks of 160-150/110 mmHg and loss of kidney function (Ur 102 mg/dl, Cr 3.5 mg/dl, estimated Glomerular Filtration Rate (eGFR) of 22 ml/min/1.73m2 considering male gender and 16.6 ml/min/1.73m2 considering female gender). Abdominal ultrasound showed chronic parenchymal nephropathy. Due to the significant reduction in eGFR, the patient was referred for kidney transplantation, but he was not included in the list because he had a creatinine clearance of 23 ml/min/1.73m2 for males and 21.5 ml/min/1.73m2 for females in the most recent tests. Hormone replacement may have contributed to the increase in the patient's blood pressure and, consequently, to the development of CKD. There is still no well-established consensus on the best way to estimate the GFR in transgender people, and it seems to be more appropriate to consider the gender to which the person self-identifies or to perform the calculation for both genders, obtaining an estimate of the range in which the patient's GFR lies.

摘要

慢性肾脏病(CKD)的发病率以及跨性别者的数量都在上升。激素替代疗法可能与包括肾脏疾病在内的不良反应的发生有关。报告一例接受激素治疗的跨性别患者发生CKD的病例。男性跨性别患者,28岁,每15天使用一次环戊丙酸睾酮,无任何合并症。病情发展为血压峰值达160 - 150/110 mmHg以及肾功能丧失(尿素102 mg/dl,肌酐3.5 mg/dl,考虑男性性别时估算肾小球滤过率(eGFR)为22 ml/min/1.73m²,考虑女性性别时为16.6 ml/min/1.73m²)。腹部超声显示慢性实质性肾病。由于eGFR显著降低,患者被转诊进行肾脏移植,但他未被列入名单,因为在最近的检查中,其男性肌酐清除率为23 ml/min/1.73m²,女性为21.5 ml/min/1.73m²。激素替代可能导致了患者血压升高,进而促成了CKD的发生。对于跨性别者估算肾小球滤过率的最佳方法,目前仍未达成明确共识,似乎更合适的做法是考虑个体自我认同的性别,或者对两种性别都进行计算以得出患者肾小球滤过率所在的范围估计值。

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