Women’s Health and Kidney Disease

A growing body of research indicates that sex and gender-specific differences exist in the mechanisms and epidemiology of chronic kidney disease (CKD). Here, the authors describe current understanding of gender and sex differences in the epidemiology, treatment and outcomes of CKD, as well as the possible underlying causes.

Chronic kidney disease (CKD) is associated with an increased risk of adverse pregnancy outcomes. Here, Wiles et al. discuss fertility issues, contraception, important comorbidities, drugs commonly used in nephrology and the effect of dialysis provision in the context of CKD. Advances in biomarkers for CKD and pre-eclampsia are also presented.

The authors present sexual dimorphism at the molecular, cellular and tissue level and suggest that it contributes to differences in disease onset, susceptibility, prevalence and treatment responses in hypertension and cardiovascular disease. Several factors that confer relative cardioprotection in women are discussed, including biological age, sex hormones, sex chromosome complement and lifestyle.

Here, four leading researchers discuss key considerations related to women's kidney health, including specific risk factors, the main challenges and barriers to care and policies and systems that could be implemented to improve the kidney health of women and their offspring.

Hypertension in pregnancy is a known risk factor for increased cardiovascular risk for both the mother and her offspring. New findings suggest the offspring of normotensive pregnancies should also be considered at risk of high blood pressure if their mother has had hypertension in other pregnancies.

Low birth weight (LBW) and intrauterine growth restriction are major contributors to the global burden of non-communicable diseases. A Norwegian registry study has confirmed that LBW is associated with an increased risk of developing end-stage renal disease by 40 years of age, which could not be explained by familial factors.

Pre-eclampsia is a common disorder of pregnancy for which the underlying mechanism is poorly understood. A genome-wide association study has now identified a pre-eclampsia susceptibility locus located near the FLT1 gene. This study brings us a step closer to dissecting the underlying causes of pre-eclampsia.

Aspirin therapy for the prevention of pre-eclampsia in unselected women is minimally effective. New data suggest that use of a screening strategy based on clinical, biochemical and biophysical factors to identify those at high risk of pre-term pre-eclampsia could improve the efficacy of preventive aspirin therapy.