Paulius Sausdravas1, Arūnas Želvys2
1 Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
2 Center of Urology, Vilnius University Hospital “Santaros Klinikos”, Vilnius, Lithuania
Abstract
Kidney stone disease affects a significant number of people, the vast majority of them are recurrent cases of the disease. Based on epidemiological data, the incidence of nephrolithiasis is 2-4 times more common among young men than women. The unequal kidney stone disease incidence distribution among individuals of the opposite sex may be caused by sex hormones levels. Therefore, we aim to summarize the literature describing the association between male testosterone and kidney stones. This paper analyses a wide range of research including experimental, case-control, and cohort studies. Link between androgens and nephrolithiasis or testosterone induced mechanisms of action in the pathogenesis has been investigated in vitro, in animal and human scientific studies. The scientists on this issue are not unanimous, so it is not possible to claim that testosterone promotes or inhibits kidney stone formation. Nevertheless, a greater number of correlation studies associate an increased risk of kidney stone disease with higher testosterone levels. These findings are also confirmed by the studied pathogenetic mechanisms of nefrolithiasis. Free testosterone diffuses into kidney cells, where it increases the expression of androgen receptors, decreases the expression of osteopontin, increases oxidative stress and the excretion of calcium ions in the urine also increases the amount of alpha-enolase proteins on the testosterone-treated renal tubular cell surface. Each of these factors promotes the formation of kidney stones. The identification of androgens as a factor in kidney stone disease is important when prescribing testosterone replacement therapy. A better understanding of the potentially causative factors and mechanisms allows for individualized treatment of the patient.
Keywords: androgens, dehydroepiandrosterone, dihydrotesterone, kidney stones, kidney calculi, nephrolithiasis, renal stones, renal calculi, urinary stones, urinary calculi, urolithiasis, testosterone.