期刊
KIDNEY INTERNATIONAL REPORTS
卷 7, 期 2, 页码 152-164出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.ekir.2021.11.003
关键词
adolescent nephrology; chronic kidney disease; contraception; female reproductive health; sexual function; uterine bleeding
资金
- Canadian Institutes of Health Research
- University of Calgary
- Libin Cardiovascular Institute
Chronic kidney disease (CKD) is increasingly affecting younger individuals, including adolescents and young adults. Female CKD patients have unique reproductive and gynecologic health concerns, but this area has not been well studied. This review explores female reproductive health and gynecologic considerations in adolescents and young adults with CKD, proposing clinical and research strategies to improve this important yet understudied aspect of kidney care.
Chronic kidney disease (CKD) increasingly affects younger people, including adolescents and young adults. CKD among females is accompanied by unique reproductive and gynecologic health concerns; though to date, this area has not been well studied. Hormonal disruptions attributed to CKD may underlie the high prevalence of abnormal uterine bleeding and influence the age of menarche in adolescents. Period poverty as a socioeconomic barrier further exacerbates the female-specific burdens of CKD. Reduced fertility in CKD is likely multifactorial and may be related to a reduction in ovarian reserve, reproductive hormone disturbances, and gonadotoxic medication use in addition to low sexual function and activity. Fertility, sexual function and activity, and risk of sexually transmitted infections increase with transplantation. Pregnancy is possible at any stage of CKD, although often accompanied by high risks of maternal and fetal complications. Contraception is thus an important consideration in CKD, but use is low and the risks and benefits of different forms in the setting of CKD are not well characterized. Though patients with CKD report reproductive health as an important element of care, many nephrologists report lack of confidence and training in this area, highlighting the need for targeted research and education. The unique reproductive health care needs of the growing transgender youth population warrant attention in nephrology training with multidisciplinary input. This review will discuss female reproductive health and gynecologic considerations in adolescents and young adults with CKD while proposing clinical and research strategies to improve this understudied yet important aspect of kidney care.
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