Effects of hemodialysis on testicular volume and oxidative stress in humans.
OBJECTIVE
Male infertility is a serious problem in patients on hemodialysis. Our understanding is that end stage renal disease or hemodialysis causes poor semen quality but the mechanism leading to impaired spermatogenesis is largely unknown.


METHODS
Testicular volume in 120 patients on maintenance hemodialysis was compared with that in age matched healthy controls. Volume was correlated with clinical findings. In 10 testicular biopsy specimens from patients on hemodialysis who visited our infertility clinic Western blotting was performed to examine the generation of 4-HNE modified proteins, which are markers of oxidative stress, and the expression of proliferating cell nuclear antigen. Interstitial fibrosis was determined by Masson's trichrome staining.


RESULTS
Mean bilateral testicular volume in patients on hemodialysis was significantly smaller than that in healthy controls (31.7 vs 36.4 ml, p <0.01) in a hemodialysis duration dependent manner (r = -0.32, p <0.01). The increase in serum ferritin correlated inversely with testicular volume (r = -0.25, p <0.01). The generation of 4-HNE modified proteins was significantly increased 3.1-fold in patients on hemodialysis, following the 60% decreased expression of proliferating cell nuclear antigen. Quantitative analysis of Masson's trichrome staining revealed increased interstitial fibrosis in patients on hemodialysis compared with that in controls (41.5% vs 14.8%, p <0.01). Serum ferritin, proliferating cell nuclear antigen expression and interstitial fibrosis correlated with the generation of 4-HNE modified proteins (p <0.05).


CONCLUSIONS
Testicular volume, which is a parameter of spermatogenesis, is impaired in patients on hemodialysis and oxidative stress is considered to be involved in the process. Serum ferritin is a useful parameter for predicting oxidative stress in the testis.
Department of Urology, Ube Industries Central Hospital, Ube, Yamaguchi, Japan. sirakkkay@aol.com
Koji
K
Shiraishi
Tomoyuki
T
Shimabukuro
Katsusuke
K
Naito
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000704:Analysis of Variance; D001707:Biopsy, Needle; D015153:Blotting, Western; D016022:Case-Control Studies; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D007248:Infertility, Male / Q000453:epidemiology* / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D018384:Oxidative Stress / Q000502:physiology*; D011336:Probability; D012016:Reference Values; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D018570:Risk Assessment; D013091:Spermatogenesis / Q000502:physiology*; D013733:Testicular Diseases / Q000453:epidemiology / Q000209:etiology / Q000473:pathology*; D013997:Time Factors