Role of the kidney in hormone metabolism and its implications in clinical medicine.

Uremia is accompanied by a variety of metabolic and endocrine disorders, due in part to impaired degradation of hormonally active peptides by the diseased kidney, and in part to the fact that the uremic environment interferes with the extrarenal degradation of certain hormones, or with their synthesis or secretion. It is not always possible to establish a direct cause and effect relationship between alterations in immunoassayable hormone levels and endocrine abnormalities because in uremia the circulating hormonal immunoreactivity frequently includes crossreacting components without biological activity and, in addition, hormonal effects on target organs are often altered. Alterations in the metabolism of pancreatic alpha and beta cell hormones and of prolactin in chronic renal failure and their effect on the metabolism of lipids and carbohydrates and on reproductive function in this condition are discussed.