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Marcora Mandreoli Antonio Santoro

U.O.C. di Nefrologia , Dialisi ed Ipertensione. Policlinico S.Orsola-Malpighi. Azienda Ospedaliero-Universitaria. Bologna - ITALY. Gender and R enal diseases. Marcora Mandreoli Antonio Santoro.

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Marcora Mandreoli Antonio Santoro

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  1. U.O.C. diNefrologia, DialisiedIpertensione Policlinico S.Orsola-Malpighi Azienda Ospedaliero-Universitaria Bologna - ITALY Gender and Renaldiseases MarcoraMandreoli Antonio Santoro

  2. Impact of gender on the incidence and progression rate ofChronicKidneyDisease (CKD) • The incidence of CKD is major in man than in women • Renal disease in women with polycystic kidney disease, IgA nephropathy, membranous glomerulopathy, and ‘chronic renal disease of unknown aetiology’ progresses at a slower rate than it does in blood pressure- and lipid levels-matched men with these diseases • CKD patients behave differently from the general population, lacking a female survival advantage during renal replacement therapy. J Neugarten. J Am SocNephrol 11:319, 2000

  3. maschi maschi maschi maschi Neugarten J. JASN 2000; 11: 319

  4. Cumulative Incidence of End Stage Renal Disease USRDS 2007

  5. Numerous studies have indicated that sex hormones affect Mammalian kidneys, causing sexual dimorphism in a variety of morphological and/or functional properties • Both α- and β-estrogen receptors (ERα and ERβ) have been detected in the kidney,and specifically in mesangial cells. • Studies in vascular tissue, studies of cultured male renal mesangial cells have shown that estradiol suppresses collagen synthesis and stimulates metalloproteinase activity via activation of estrogen receptors

  6. Effectsof sex hormones Haemodinamicpathway Silbiger SR Kidney International (2011) 79, 382–384

  7. Gender-dependenteffectsofaging on the kidney - + A.L.Gava,et al. Braz J MedBiolRes 2011; 44: 905-913

  8. Cumulative survival of women and men with or without Diabetes 5 years after the start of dialysis Without T2DM F M M with T2DM F Carrero J J et al. Nephrol. Dial. Transplant. 2011;26:270-276

  9. Hypothesis • Reduced levels of estrogen and imbalance in the expression of estrogen receptors is one of the contributing mechanisms for the loss of the female sex as a protective factor in diabetes • Estrogen is renoprotectiveby attenuating the decline in renal function and preventing renal pathologyassociatedwithdiabeticnephropathy

  10. Estrogenreceptors in the kidney

  11. Estrogenattenuatesrenalstructuraldamage in diabeticnephropathy

  12. Estrogenattenuates the decline in renalfunction in diabeticnephropathy

  13. How sex steroid may modulate renal injury

  14. Conclusions • Scant attention is currently paid to the important biological and psychological differences between men and women with CKD • There is a scarcity of information about the role of menopause in modifying risk profiling and the involvement of sex hormones in the disease • Sex hormones still have a role after menopause and sex specific tissue responses and cellular differences also exist • Females develop less age-dependent loss of renal function, in part because of cardiorenal protective effects of estrogens, but estrogen acts via multiple pathways, not all of which are beneficial for renal function • The true role of sex hormones in conditioning the CKD progression is not completely clear: most probably they don’t have a direct causal role, but they act as permissive factors.

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