Sex differences in kidney disease and physiology

This Review summarizes our current understanding of sex differences in renal fluid and electrolyte transporters, based primarily on studies in rodents. The authors describe the physiological consequences of these differences, based on information from experimental studies and from model predictions, and discuss the differential impact of sex on transporter regulation by hormones, diet and acid–base status.

In this Review, Franck Mauvais-Jarvis discusses how adaptive selection during evolution could have shaped sex differences in energy partitioning, adipose tissue function and distribution, and glucose homeostasis. He also discusses the hormonal and genetic mechanisms that underlie these sex differences and their implications for metabolic disease and sex-based precision medicine.

Improved understanding of kidney disease from a sex- and gender-specific perspective is needed to improve patient care. Here, the authors discuss differences in the epidemiology, management and outcomes of acute kidney injury, chronic kidney disease and kidney failure in men and women.

Sex differences in immune cell function and immune responses affect the development and outcome of diverse diseases. Here, the authors review current understanding of sex differences in immunity. They describe the key mechanisms that mediate sex differences in immune responses and discuss the functional relevance of such differences for immune-related diseases.

Improved understanding of the impact of sex and gender-related factors on human health and disease and the inclusion of people of all genders in research studies is necessary to reduce health inequities and enable a more personalized approach to patient care.

The importance of incorporating factors related to sex and gender in all aspects of research is increasingly recognized. Kidney disease pathophysiology, presentation, response to therapy and outcomes differ by sex and gender, but these factors are often not considered in basic and clinical studies. It is time for nephrology to catch up.

Chronic kidney disease (CKD) is highly prevalent in women in perimenopause and menopause. Both CKD and menopause affect several important pathologies, such as cardiovascular disease (CVD) and bone mineral disease. More research is needed to better understand the relationships between menopause, CKD, CVD and bone disease.