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Sex and Gender Differences in AKI.

Lisa M Curtis¹

¹Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama.

|November 22, 2023

Summary

Women generally show protection from acute kidney injury (AKI), but this diminishes after menopause. Gonadal hormones and other sex-based factors influence AKI susceptibility, requiring further research, especially in transgender individuals.

Area of Science:

Nephrology
Endocrinology
Genetics

Background:

Sex differences in acute kidney injury (AKI) are well-documented, with women typically exhibiting protection compared to men.
This protective effect in women is reduced post-menopause, a phenomenon observed in both human and animal models.
Gonadal hormones, such as estrogen and testosterone, are implicated as key modulators of AKI incidence, severity, and progression.

Approach:

This review discusses potential contributors to observed sex differences in AKI.
It examines the roles of gonadal hormones, cellular and molecular changes, sex chromosomal complement, and epigenetic influences.
The impact of gender-affirming hormone therapy on AKI susceptibility in transgender patients is highlighted as an area needing further investigation.

Key Points:

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Estrogen and testosterone modulate susceptibility to AKI in animal models.
Molecular pathways involved in AKI initiation and progression may be influenced by gonadal hormones.
Sex-based differences in gene and protein expression, influenced by chromosomal complement and epigenetics, contribute to AKI susceptibility.

Conclusions:

Understanding the mechanisms behind sex-based protection in AKI can provide a more comprehensive view of the condition.
Elucidating these mechanisms may lead to novel therapeutic interventions for AKI.
Further research is crucial to address the unique considerations of AKI susceptibility in transgender individuals undergoing hormone therapy.