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Sexual Dysfunction Among Patients With Chronic Kidney Disease. Semin Nephrol 2022; 41:534-549. [PMID: 34973698 DOI: 10.1016/j.semnephrol.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Sexual dysfunction (SD) in patients with chronic kidney disease is common and negatively impacts quality of life. SD is often under-appreciated because of overall low awareness. Diagnosis of SD is subjective, and manifestations can be different among men and women. Causes of SD are multifactorial, including psychological disorders, hormonal imbalances, vascular disorders, neurological disorders, and medication side effects. Non-specific approaches to improving sexual function include addressing underlying psychological disorders, promoting lifestyle modifications, optimizing dialysis care, and facilitating successful kidney transplantation, whereas treatment with phosphodiesterase type 5 inhibitor, hormone replacement, and mechanical devices can be offered to patients with specific indications.
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Szypulska-Koziarska D, Wilk A, Marchelek-Myśliwiec M, Śleboda-Taront D, Wiszniewska B. Tacrolimus-Based Immunosuppressive Therapy Influences Sex Hormone Profile in Renal-Transplant Recipients-A Research Study. BIOLOGY 2021; 10:biology10080709. [PMID: 34439942 PMCID: PMC8389270 DOI: 10.3390/biology10080709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/02/2021] [Accepted: 07/22/2021] [Indexed: 11/23/2022]
Abstract
Simple Summary Although renal-transplant-recipients can lead much more comfortable life in comparison to patients on dialysis, they need to face other problems. One of them is lifetime immunosuppressive therapy on daily basis. Immunosuppressive regimen contains usually three different drugs and although each one of them is crucial to keep graft in good condition and to suppress immune response against the transplanted organ, they influence, among the other, reproductive system. In current paper we have observed that immunosuppressive therapy based on tacrolimus significantly affected the hormonal balance of sex hormones in both men and women. It is of great importance, as nowadays infertility is rising problem even in health people, therefore more attention should be paid to choose the best suitable immunosuppressive regiment for recipient in reproductive age. Abstract It is estimated that approximately 20% of couples suffer from infertility worldwide and within renal-transplant recipients, this problem is 10 times more common. An intake of immunosuppressants may lead to hormonal imbalance. The aim of the study was to investigate the influence of tacrolimus-based therapy on the hormonal status of grafted patients. Blood samples were obtained from patients from the Department of Nephrology, Transplantology, and Internal Medicine of Independent Public Clinical Hospital No. 2, Pomeranian Medical University. All 121 patients had stable graft function for over 6 months. The blood plasma concentrations of luteinizing hormone, follicle-stimulating hormone, prolactin, testosterone, estradiol, cortisol were assessed by the electrochemiluminescence method. We observed decreased levels of prolactin (11.9 ng/mL) and cortisol (87.4 μg/mL) in patients under tacrolimus-based therapy. Tacrolimus-based therapy was also associated with increased testosterone and follicle-stimulating hormone in males, 4.04 ng/mL and 6.9 mLU/mL, respectively, and decreased testosterone levels in females, 0.121 ng/mL. We also assessed that immunosuppressive therapy based on tacrolimus is less nephrotoxic in comparison to other regimens. Concluding, tacrolimus-based therapy may influence the hormonal status of transplant recipients in the current study. Results presented here are believed to be helpful for clinicians and patients, especially within the aspect of willingness for biological offspring.
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Affiliation(s)
- Dagmara Szypulska-Koziarska
- Department of Histology and Embryology, Pomeranian Medical University, Powst. Wlkp. 72, 70-111 Szczecin, Poland; (A.W.); (B.W.)
- Correspondence: ; Tel.: +48-91-466-16-81
| | - Aleksandra Wilk
- Department of Histology and Embryology, Pomeranian Medical University, Powst. Wlkp. 72, 70-111 Szczecin, Poland; (A.W.); (B.W.)
| | - Małgorzata Marchelek-Myśliwiec
- Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, Powst. Wlkp. 72, 70-111 Szczecin, Poland;
| | - Daria Śleboda-Taront
- Department of Laboratory Medicine, Pomeranian Medical University, Powst. Wlkp. 72, 70-111 Szczecin, Poland;
| | - Barbara Wiszniewska
- Department of Histology and Embryology, Pomeranian Medical University, Powst. Wlkp. 72, 70-111 Szczecin, Poland; (A.W.); (B.W.)
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Jensen NB, Justesen SD, Larsen A, Ernst E, Pedersen LH. A systematic overview of the spermatotoxic and genotoxic effects of methotrexate, ganciclovir and mycophenolate mofetil. Acta Obstet Gynecol Scand 2021; 100:1557-1580. [PMID: 33755191 DOI: 10.1111/aogs.14151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/23/2021] [Accepted: 03/14/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Immunosuppressant drugs are increasingly being used in the reproductive years. Theoretically, such medications could affect fetal health either through changes in the sperm DNA or through fetal exposure caused by a presence in the seminal fluid. This systematic overview summarizes existing literature on the spermatotoxic and genotoxic potentials of methotrexate (MTX), a drug widely used to treat rheumatic and dermatologic diseases, and mycophenolate mofetil (MMF), which alone or supplemented with ganciclovir (GCV) may be crucial for the survival of organ transplants. MATERIAL AND METHODS The systematic overview was performed in accordance with the PRISMA guidelines: A systematic literature search of the MEDLINE and Embase databases was done using a combination of relevant terms to search for studies on spermatotoxic or genotoxic changes related to treatment with MTX, GCV or MMF. The search was restricted to English language literature, and to in vivo animal studies (mammalian species) and clinical human studies. RESULTS A total of 102 studies were identified, hereof 25 human and 77 animal studies. For MTX, human studies of immunosuppressive dosages show transient effect on sperm quality parameters, which return to reference values within 3 months. No human studies have investigated the sperm DNA damaging effect of MTX, but in other organs the genotoxic effects of immunosuppressive doses of MTX are fluctuating. In animals, immunosuppressive and cytotoxic doses of MTX adversely affect sperm quality parameters and show widespread genotoxic damages in various organs. Cytotoxic doses transiently change the DNA material in all cell stages of spermatogenesis in rodents. For GCV and MMF, data are limited and the results are indeterminate, for which reason spermatotoxic and genotoxic potentials cannot be excluded. CONCLUSIONS Data from human and animal studies indicate transient spermatotoxic and genotoxic potentials of immunosuppressive and cytotoxic doses of MTX. There are a limited number of studies investigating GCV and MMF.
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Affiliation(s)
| | | | - Agnete Larsen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Erik Ernst
- Department of Biomedicine, Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Laboratory for Reproduction, Institute of Anatomy, Aarhus University, Aarhus, Denmark
| | - Lars H Pedersen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
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Takamoto D, Kawahara T, Takeshima T, Kuroda S, Mochizuki T, Makiyama K, Yumura Y, Teranishi JI, Uemura H. The Treatment of Male Infertility After Allograft Renal Transplantation: A Case Series. ACTA ACUST UNITED AC 2019. [DOI: 10.2174/1874303x01912010001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Renal transplantation is a useful option for allowing female renal failure patients of childbearing age to achieve pregnancy. However, there have been a few reports on the effects of renal transplantation on infertility treatment in male renal failure patients. We herein report two cases in which male patients underwent infertility treatment after renal transplantation.
Case Presentation:
Case 1: A 51-year-old Asian (Japanese) man underwent transplantation (the donor was his wife) for renal failure due to Autosomal Dominant Polycystic Kidney Disease (ADPKD). At two years after transplantation, he visited the reproduction center in our institute due to infertility. A semen analysis revealed oligoasthenozoospermia. He ultimately failed to achieve pregnancy and gave up on infertility treatment.
Case 2: A 47-year-old Asian (Japanese) man underwent renal transplantation (the donor was his sister) due to renal failure caused by diabetes mellitus. At three years after renal transplantation, he visited the reproduction center in our institute for infertility. Due to ejaculation disability and the absence of sperm in the patient’s urine after masturbation, he was diagnosed with anejaculation. Thus, testicular sperm extraction (TESE) was performed. Twenty-three motile spermatozoa were successfully retrieved by microdissection TESE (micro-TESE). ICSI was subsequently performed and a good embryo was transferred. His wife achieved pregnancy and is expected to deliver this October.
Conclusion:
We report two cases of male infertility treatment after renal transplantation.
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Rayburn ER, Gao L, Ding J, Ding H, Shao J, Li H. FDA-approved drugs that are spermatotoxic in animals and the utility of animal testing for human risk prediction. J Assist Reprod Genet 2018; 35:191-212. [PMID: 29063992 PMCID: PMC5845034 DOI: 10.1007/s10815-017-1062-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 10/05/2017] [Indexed: 01/18/2023] Open
Abstract
PURPOSE This study reviews FDA-approved drugs that negatively impact spermatozoa in animals, as well as how these findings reflect on observations in human male gametes. METHODS The FDA drug warning labels included in the DailyMed database and the peer-reviewed literature in the PubMed database were searched for information to identify single-ingredient, FDA-approved prescription drugs with spermatotoxic effects. RESULTS A total of 235 unique, single-ingredient, FDA-approved drugs reported to be spermatotoxic in animals were identified in the drug labels. Forty-nine of these had documented negative effects on humans in either the drug label or literature, while 31 had no effect or a positive impact on human sperm. For the other 155 drugs that were spermatotoxic in animals, no human data was available. CONCLUSION The current animal models are not very effective for predicting human spermatotoxicity, and there is limited information available about the impact of many drugs on human spermatozoa. New approaches should be designed that more accurately reflect the findings in men, including more studies on human sperm in vitro and studies using other systems (ex vivo tissue culture, xenograft models, in silico studies, etc.). In addition, the present data is often incomplete or reported in a manner that prevents interpretation of their clinical relevance. Changes should be made to the requirements for pre-clinical testing, drug surveillance, and the warning labels of drugs to ensure that the potential risks to human fertility are clearly indicated.
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Affiliation(s)
| | - Liang Gao
- Department of Clinical Laboratory Sciences, Nantong Maternity and Child Health Hospital, Nantong, 226018, China
| | - Jiayi Ding
- Department of Reproductive Medicine, Nantong Maternity and Child Health Hospital, Nantong, 226018, China
| | - Hongxia Ding
- Pharmacodia (Beijing) Co., Ltd, Beijing, 100085, China
| | - Jun Shao
- Department of Reproductive Medicine, Nantong Maternity and Child Health Hospital, Nantong, 226018, China
| | - Haibo Li
- Department of Clinical Laboratory Sciences, Nantong Maternity and Child Health Hospital, Nantong, 226018, China.
- Department of Reproductive Medicine, Nantong Maternity and Child Health Hospital, Nantong, 226018, China.
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Georgiou GK, Dounousi E, Harissis HV. Calcineurin inhibitors and male fertility after renal transplantation - a review. Andrologia 2015; 48:483-90. [DOI: 10.1111/and.12477] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2015] [Indexed: 12/26/2022] Open
Affiliation(s)
- G. K. Georgiou
- Unit for Solid Organ Transplantation; Department of Surgery; University Hospital of Ioannina; Ioannina Greece
| | - E. Dounousi
- Department of Nephrology; University Hospital of Ioannina; Ioannina Greece
| | - H. V. Harissis
- Unit for Solid Organ Transplantation; Department of Surgery; University Hospital of Ioannina; Ioannina Greece
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Berkkanoglu M, Bulut H, Coetzee K, Ozgur K. Intracytoplasmic sperm injection in male renal transplant recipients. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2015. [DOI: 10.1016/j.mefs.2014.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Testicular Function, Semen Quality, and Fertility in Young Men After Renal Transplantation During Childhood or Adolescence. Transplantation 2014; 98:987-93. [DOI: 10.1097/tp.0000000000000173] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Balmori C, Guillén A, Montans J, Bronet F, García-Velasco JA. Successful ICSI in an azoospermic and kidney transplant man with type 1 primary hyperoxaluria and first histopathological testicular findings described in the literature. Andrologia 2014; 47:109-11. [PMID: 24456123 DOI: 10.1111/and.12230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2013] [Indexed: 01/17/2023] Open
Abstract
In this report, we describe for the first time a pregnancy using sperm retrieved from an azoospermic man with kidney transplant due to type I primary hyperoxaluria. It is the first case that we were able to find in the literature for both male infertility and hystopathologic findings.
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Affiliation(s)
- C Balmori
- IVI Madrid, Rey Juan Carlos University, Madrid, Spain
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Effect of Uremia on Semen Quality and Reproductive Function in Humans. Cell Biochem Biophys 2012; 62:29-33. [DOI: 10.1007/s12013-011-9254-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Xu HM, Li HG, Xu LG, Zhang JR, Chen WY, Shi QX. The decline of fertility in male uremic patients is correlated with low expression of the cystic fibrosis transmembrane conductance regulator protein (CFTR) in human sperm. Hum Reprod 2011; 27:340-8. [PMID: 22131388 DOI: 10.1093/humrep/der403] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The present study was designed to investigate the possible association between infertility of male uremic patients and expression of the cystic fibrosis transmembrane conductance regulator (CFTR) protein in their sperm. METHODS Semen was collected and analyzed. Serum levels of FSH, LH and testosterone were measured by radioimmunoassay. The sperm CFTR expressions of 21 uremic patients and 15 renal transplant patients were measured and compared with those of 32 healthy and 33 infertile men. RESULTS Only 9 ± 5.9% of sperm from uremic patients expressed CFTR, significantly less than those of the renal transplant patients (29 ± 14.3%, P< 0.001), the infertile men (42 ± 20.7%, P< 0.001) and the healthy men (51 ± 20.5%, P< 0.001). Furthermore, significantly fewer sperm from renal transplant patients expressed CFTR than those of the infertile men (P< 0.05) and the healthy men (P< 0.01). LH levels in uremic patients were significantly higher than in all other groups, whereas FSH levels in uremic patients were only significantly higher than in infertile and healthy men. There was no significant difference in testosterone level among the four categories. CONCLUSIONS Sperm CFTR expression is depressed in uremic patients but recovers to some degree after renal transplant along with some improvement in fertility, indicating a 'reversible' change. These results suggest that the CFTR expression rate in sperm is correlated with the decline of uremic patients' fertility, and may be considered as a potential marker to assess the fertility of male uremic patients.
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Affiliation(s)
- Hui Ming Xu
- Department of Andrology, Zhejiang Family Planning Research Institute, Hangzhou, Zhejiang 310012, People's of Republic China
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Kyrieleis HA, Löwik MM, Pronk I, Cruysberg HR, Kremer JA, Oyen WJ, van den Heuvel BL, Wetzels JF, Levtchenko EN. Long-term outcome of biopsy-proven, frequently relapsing minimal-change nephrotic syndrome in children. Clin J Am Soc Nephrol 2009; 4:1593-600. [PMID: 19808243 PMCID: PMC2758253 DOI: 10.2215/cjn.05691108] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Accepted: 07/30/2009] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Frequently relapsing and steroid-dependent minimal-change nephrotic syndrome (MCNS) that originates in childhood can persist after puberty in >20% of patients. These patients require immunosuppressive treatment during several decades of their life. We examined long-term adverse effects of persistent nephrotic syndrome and immunosuppressive medications, focusing on renal function, growth, obesity, osteoporosis, hypertension, ocular complications, and fertility in adult patients with biopsy-proven childhood-onset MCNS. Molecular analysis was performed to evaluate a possible association of a complicated course of MCNS with podocyte gene mutations. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We performed a prospective clinical examination of 15 adult patients that included serum and urine analysis; dual-energy x-ray absorptiometry; ophthalmologic examination; semen examination; and molecular analysis of NPHS1, NPHS2, CD2AP, and ACTN4 genes. RESULTS All patients had normal GFR. Most frequent long-term complications were hypertension (in seven of 15 patients) and osteoporosis in one third of patients. Oligozoospermia was found in one patient, reduced sperm motility in four of eight patients, and teratozoospermia in six of eight patients. Ophthalmologic examination revealed myopia in 10 of 15 patients and cataract in three of 15 patients. CONCLUSIONS Children with MCNS that persists after puberty are at risk for complications such as osteoporosis, hypertension, cataract, and sperm abnormalities. Our study underscores a need for more effective and less toxic therapies for relapsing MCNS.
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Affiliation(s)
| | | | | | | | | | | | - Bert L.P. van den Heuvel
- Department of Pediatric Nephrology
- Laboratory of Pediatrics and Neurology
- Department of Pediatric Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Jack F.M. Wetzels
- Department of Nephrology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands; and
| | - Elena N. Levtchenko
- Department of Pediatric Nephrology
- Department of Pediatric Nephrology, University Hospitals Leuven, Leuven, Belgium
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