The androgen responsiveness of the kidney has led to speculation that androgen therapy in patients with chronic renal failure or nephrotic syndrome might improve or slow deterioration in underlying renal function. This hypothesis arose from animal experiments showing androgen-induced renal hypertrophy and protection against certain nephrotoxins (40). Clinical evidence for renotrophic effects of androgen therapy has been comprehensively reviewed (40,41) but remains ambiguous because of the lack of adequately powered, placebo-controlled studies. The best evidence for a renotrophic effect of androgen therapy derives from two older studies with significant methodological limitations. The first was a placebo-controlled study of elderly patients without renal disease (42) in which indices of both glomerular and tubular function were improved by nandrolone phenylpropionate (25 mg injections weekly) after approx 40 wk. The second, but uncontrolled, study showed apparent improvements in well-being and biochemical tests of renal function in 88 patients with uremia treated with various doses of injectable testosterone propionate (50 mg/d) or cypionate (100 mg/d to monthly) and oral fluoxymesterone (5 mg/d) (43), but detailed findings and analysis were lacking. Although renotrophic effects have a biological basis, the lack of adequate clinical trials precludes an established role for androgen therapy in the conservative management of chronic renal failure per se.
On the contrary, experimental studies of rodent kidney transplantation suggest that androgen administration may be detrimental to renal function. In rats with kidney transplants, exogenous androgen therapy increased, whereas androgen blockade or estradiol administration reduced histological and functional features of chronic allograft nephropathy (44,45). Further studies of human allograft recipients are required to determine whether these findings are relevant to humans, in which case caution in the use of androgen therapy after renal transplantation might be indicated.
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