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Kidney Week

Abstract: PO2240

Effect of Reproductive History on Kidney Structure and Function in Women

Session Information

Category: Women’s Health and Kidney Diseases

  • 2000 Women’s Health and Kidney Diseases

Authors

  • Kattah, Andrea G., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Mullan, Aidan F., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Garovic, Vesna D., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Smith, Maxwell L., Mayo Clinic, Scottsdale, Arizona, United States
  • Denic, Aleksandar, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Stegall, Mark D., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Rule, Andrew D., Mayo Clinic Minnesota, Rochester, Minnesota, United States
Background

Varying estrogen levels from menarche to menopause and physiological changes of pregnancy may impact kidney health in women.

Methods

Female kidney donors from 2000 to 2017 were sent a survey on reproductive health, including menarche, pregnancy, and menopause. At the time of donation, donors had a medical evaluation, measured GFR, 24h urine albumin, CT angiography of kidneys, and a kidney biopsy. Kidney volumes were calculated from CT images. Non-sclerosed and globally sclerosed glomeruli counts and % interstitial fibrosis/tubular atrophy (IFTA) were assessed via kidney biopsy. Kidney function and structural findings at the time of donation were assessed by differences in reproductive factors prior to donation adjusting for age.

Results

There were 673 women studied with a mean (SD) age at donation of 47.4 (11.4) and 74% had at least one pre-donation birth. As compared to non-parous women, parous women had a higher total cortical volume (6.1%, p=0.009) and medullary volume (6.7%, p=0.038). However, among parous women, additional parity was not associated with further increases in kidney volumes. Among the 218 post-menopausal women, each year since menopause was associated with a higher likelihood of IFTA > 0% on biopsy independent of age (OR=1.052, p=0.027). With each 5-year increase in reproductive lifespan (years from menarche to menopause), there was a lower likelihood of having IFTA > 0% (OR=0.81, p=0.048). We did not find any significant association between past reproductive factors on GFR, urine albumin, glomerulosclerosis, or nephron number at the time of donation.

Conclusion

Past pregnancy is associated with larger kidneys among healthy women suggesting that the enlargement of kidneys with pregnancy does not fully resolve after delivery. Among healthy post-menopausal women, longer duration of menopause and shorter reproductive lifespan associated with detectable IFTA on kidney biopsy consistent with a protective effect of estrogen on preventing subclinical kidney injury.

Funding

  • NIDDK Support