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Sex Differences in Renal and Cardiovascular Function: Physiology and Pathophysiology

Sex difference in urine concentration across differing ages, sodium intake, and level of kidney disease

¹Institut National de la Santé et de la Recherche Médicale Unité 652 and Université Paris Descartes, Paris; and ²Institut National de la Santé et de la Recherche Médicale Unité 557; Institut National de la Recherche Agronomique, Unité 1125, Conservatoire National des Arts et Métiers, Paris, France

Submitted 15 July 2006 ; accepted in final form 19 September 2006

Men are known to be at greater risk of urolithiasis and cardiovascular and renal diseases than women. Previous studies suggest that greater urine concentration is associated with acceleration of progression of chronic kidney disease (CKD), increased urinary albumin excretion, and delayed renal sodium excretion. The present review addresses possible sex-related differences in urine volume and osmolality (U_osm) that could participate in this male risk predominance. Because of the scarcity of information, we reanalyzed 24-h urine data collected previously by different investigators for other purposes. In nine studies concerning healthy subjects (6 studies) or patients with CKD or diabetes mellitus, U_osm (or another index of urine concentration based on the urine/plasma creatinine concentration ratio) was 21–39% higher (i.e., about a 150 mosm/kgH₂O difference) in men than in women. Urine volume was not statistically different. Thus, the larger osmolar load of men (related to their higher food intake) is excreted in a more concentrated urine with no difference in urine volume. This sex difference was not influenced by the level of sodium excretion and was still present in CKD patients. Sex differences in thirst threshold, AVP level, and other regulatory mediators may all contribute to the higher male U_osm. Because of the previously demonstrated adverse effects of vasopressin and/or high urine concentrating activity, the greater tendency of men to concentrate urine could participate in their greater susceptibility to urolithiasis and hypertension and to the faster progression towards end-stage renal failure.

lithiasis; vasopressin; thirst; urine volume; hypertension

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