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Chien TM, Lu YM, Li CC, Wu WJ, Chang HW, Chou YH. A retrospective study on sex difference in patients with urolithiasis: who is more vulnerable to chronic kidney disease? Biol Sex Differ 2021; 12:40. [PMID: 34099045 PMCID: PMC8185917 DOI: 10.1186/s13293-021-00382-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/17/2021] [Indexed: 11/12/2022] Open
Abstract
Background Urolithiasis is considered a vital public health issue with a substantial burden on kidney function. Additionally, only few reports focused on the gender difference in patients with urolithiasis. Therefore, this study aimed to compare the clinical characteristics of sex difference and their potential risk for chronic kidney disease (CKD) in patients with urolithiasis. Methods Patients diagnosed with stone disease from 2013 to 2018 were retrospectively reviewed and divided into two groups by gender. Clinical demographic characteristics, stone location, stone composition, urine chemistries, and renal function were investigated. Univariate and multivariate analyses were used to assess the relationship and potential risk of CKD between sex groups. Results A total of 1802 patients were included: 1312 from men and 490 from women. Female patients had a higher rate of hypertension, diabetes, and dyslipidemia. Male patients predominantly had calcium-containing stones, especially calcium oxalate stone, uric acid stone, and struvite stone. Carbonate apatite stone was more frequently found in women. Complex surgeries such as percutaneous nephrolithotomy (PCNL) and ureteroscopic lithotripsy (URSL) were more frequently performed in women than that in men. Multivariate analysis confirmed that age > 60 years (odds ratios [ORs] = 6.36; 95% confidence interval [CI], 3.8–10.8), female sex (ORs = 5.31; 95% CI 3.3–8.4), uric acid stone (ORs = 3.55; 95% CI 2.0–6.4), hypertension (OR = 7.20; 95% CI 3.8–13.7), and diabetes (OR = 7.06; 95% CI 3.1–16.2) were independent predictors of poor prognoses in CKD. Conclusions The female gender is significantly associated with a higher prevalence of CKD among patients with urolithiasis. Therefore, women with stone disease may need close renal function monitoring during follow-up.
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Affiliation(s)
- Tsu-Ming Chien
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan.,Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, No.100, Tzyou 1st Road, Kaohsiung, 80756, Taiwan.,Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, 80756, Taiwan
| | - Yen-Man Lu
- Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, No.100, Tzyou 1st Road, Kaohsiung, 80756, Taiwan.,Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, 80756, Taiwan.,Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Ching-Chia Li
- Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, No.100, Tzyou 1st Road, Kaohsiung, 80756, Taiwan.,Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, 80756, Taiwan
| | - Wen-Jeng Wu
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan.,Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, No.100, Tzyou 1st Road, Kaohsiung, 80756, Taiwan.,Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, 80756, Taiwan
| | - Hsueh-Wei Chang
- Department of Biomedical Science and Environmental Biology, College of Life Science, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan.,Cancer Center, Kaohsiung Medical University Hospital, Kaohsiung, 807, Taiwan.,Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
| | - Yii-Her Chou
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan. .,Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, No.100, Tzyou 1st Road, Kaohsiung, 80756, Taiwan. .,Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, 80756, Taiwan.
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Khalil R, Simitsidellis I, Kim NR, Jardi F, Schollaert D, Deboel L, Saunders P, Carmeliet G, Claessens F, Vanderschueren D, Decallonne B. Androgen action on renal calcium and phosphate handling: Effects of bisphosphonate treatment and low calcium diet. Mol Cell Endocrinol 2020; 514:110891. [PMID: 32533994 DOI: 10.1016/j.mce.2020.110891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/05/2020] [Accepted: 06/03/2020] [Indexed: 01/25/2023]
Abstract
Renal calcium and phosphate handling is an important contributor to mineral homeostasis and bone health and the androgen receptor (AR) is highly expressed in the kidney. We investigated the short term effects of androgen deprivation on renal calcium and phosphate reabsorption, independent of their effects on bone. Two weeks following orchidectomy (ORX) of adult mice, bone loss occurred along with hypercalciuria, which was similarly prevented by testosterone and dihydrotestosterone supplementation. Treatment with bisphosphonates prior to ORX also inhibited hypercalciuria, indicating that the calcium flux originated from the bone. Renal calcium and phosphate transporter expression was increased post-ORX, independent of bisphosphonates. Furthermore, androgen deprivation appeared to stimulate local synthesis of 1,25(OH)2D3. When bisphosphonate-treated mice were fed a low calcium diet, bone resorption was no longer blocked and secondary hyperparathyroidism developed, which was more pronounced in ORX mice than sham-operated mice. In conclusion, this study shows that androgen deprivation increased renal calcium and phosphate transporter expression, independent of bone, and underlines the importance of adequate intestinal calcium supply in circumstances of androgen deprivation and bisphosphonate treatment.
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Affiliation(s)
- Rougin Khalil
- Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Aging, KU Leuven, Belgium
| | - Ioannis Simitsidellis
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, United Kingdom
| | - Na Ri Kim
- Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Aging, KU Leuven, Belgium
| | - Ferran Jardi
- Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Aging, KU Leuven, Belgium
| | - Dieter Schollaert
- Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Aging, KU Leuven, Belgium
| | - Ludo Deboel
- Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Aging, KU Leuven, Belgium
| | - Philippa Saunders
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, United Kingdom
| | - Geert Carmeliet
- Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Aging, KU Leuven, Belgium
| | - Frank Claessens
- Molecular Endocrinology Laboratory, Department of Cellular and Molecular Medicine, KU Leuven, Belgium
| | - Dirk Vanderschueren
- Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Aging, KU Leuven, Belgium
| | - Brigitte Decallonne
- Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Aging, KU Leuven, Belgium.
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Nackeeran S, Katz J, Ramasamy R, Marcovich R. Association between sex hormones and kidney stones: analysis of the National Health and Nutrition Examination Survey. World J Urol 2020; 39:1269-1275. [PMID: 32504317 DOI: 10.1007/s00345-020-03286-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/28/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Increasing age, male gender, and metabolic syndrome are associated with kidney stone formation. As sex hormones change with age, gender, and metabolic syndrome, we hypothesized that sex hormones may underlie the physiologic changes affecting stone formation. METHODS We analyzed the relationships between testosterone, estradiol, and history of kidney stones using data from 10,193 participants in the Continuous National Health and Nutrition Examination Survey (NHANES) database from 2013-2016. We performed logistic regression analysis to analyze the predictive value of low testosterone and low estradiol on the history of kidney stones in both males and females. Self-reported history of kidney stone diagnosis was the outcome. RESULTS After adjusting for risk factors known to be associated with nephrolithiasis such as age, race, BMI, and medical comorbidities including: gout, angina, coronary disease, stroke, asthma, hypertension, and diabetes, multiple regression analysis demonstrated that there is no independent association between sex hormones (testosterone and estradiol) and history of kidney stones in either males or females. CONCLUSIONS There appears to be no association between sex hormones and history of kidney stones. Whether there is a more complex interaction of sex hormone levels and the shared association with factors such as metabolic syndrome requires additional investigation. Further studies matching menopausal status for women are necessary to further investigate the potential relationship between estrogen and kidney stones.
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Affiliation(s)
| | - Jonathan Katz
- Department of Urology, University of Miami, Miami, FL, USA
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