1. Nat. Rev. Nephrol. doi:10.1038/nrneph.2017.187
Figure 1 Endocrine effects of chronic kidney disease on the hypothalamic–pituitary–ovarian axis
Figure 1 | Endocrine effects of chronic kidney disease on the hypothalamic–pituitary–ovarian axis. a | During the midcycle (late follicular) phase of the menstrual cycle, high levels of oestrogen (OE) confer positive feedback, sensitizing the pituitary to the effects of gonadotropin-releasing hormone (GnRH) from the hypothalamus. As a result, a surge of luteinizing hormone (LH) in midcycle occurs, which stimulates ovulation. Following ovulation, progesterone (PROG) is secreted from the corpus luteum, which acts to prepare the endometrium for implantation. If implantation does not occur, PROG levels fall and menstruation follows. b | Hypothesized hormone profile during the menstrual cycle in chronic kidney disease (CKD). Serum LH levels are increased in CKD, but the absence of an LH surge in the late follicular phase of the menstrual cycle means that ovulation does not occur. Without ovulation and the development of a corpus luteum, PROG levels do not rise. OE levels are low throughout the cycle. c | The anterior pituitary gland secretes follicle-stimulating hormone (FSH), LH and prolactin under hypothalamic control. FSH and LH act synergistically to regulate gonad function, including sex steroid production and gametogenesis in the ovary. At the midpoint of the menstrual cycle, positive OE feedback leads to a surge in LH, which triggers ovulation. Prolactin production is increased only during pregnancy and lactation, when it stimulates breast development and lactation while inhibiting ovulation. d | Low OE levels in CKD confer negative feedback to the hypothalamus–pituitary axis. The absence of an LH surge leads to anovulation. Impaired renal clearance of prolactin causes inhibition of GnRH secretion from the hypothalamus, also suppressing ovulation. Cyclophosphamide is gonadotoxic, causing age and dose-dependent premature ovarian failure. The level of CKD at which these changes occur remains unknown.
Wiles, K. S. et al. (2018) Reproductive health and pregnancy in women with chronic kidney disease
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