Understanding the opposite effects of sex hormones in mediating renal injury.

According to epidemiological studies, chronic kidney disease (CKD) affects more women than men, but the incidence of end-stage renal disease (ESRD) is higher in men than in women. However, most of these studies have not considered the CKD incidence in women of reproductive or postmenopausal age, and even less with hormone replacement therapy. Some meta-analyses have reported an exacerbated progression of CKD in men compared with women. Consequently, in most of the experimental models of renal injury, males of reproductive age exhibit more abnormalities in renal function and structure that lead to greater progression to CKD than females, which suggests that these differences are mediated by sex hormones rather other factors. This review intents to show the mechanisms regulated by estrogen or testosterone that may explain the different risk and evolution of the renal diseases between males and females. Regardless of the initial cause of kidney disease, sex hormones have been implicated in modulating vascular tone, oxidative stress, inflammation and apoptosis. Finally, our previous study highlights the mechanisms by which the transition from AKI to CKD does not occur in female rats commonly as it does in male rats. This review not only identifies sex differences in several kidney diseases but also supports potential therapeutic opportunities to reduce or prevent the progression of CKD and highlights the importance of considering sex differences in the design of any clinical study.