Endocrinology and Systemic Diseases

Endocrine and renal pathophysiology are interwoven at a granular level, and physicians involved in both disciplines must work closely together to appreciate diagnostic subtleties that can make a substantial difference in the therapeutic approach. Diabetes is the leading cause of end-stage renal disease worldwide. Diabetic nephropathy (DN) affects one-third of patients with diabetes mellitus and is associated with considerable cardiovascular morbidity and mortality. However, at histological level, diabetic patients show a high prevalence of nondiabetic renal diseases or mixed forms; thus, the term diabetic nephropathy should be used only for biopsy-proven kidney disease caused by diabetes. As the treatment may diverge, and the risk profile is comparable to that of the general population, renal biopsy should be performed to allow a proper diagnosis and prognosis. Obesity, on the other hand, is becoming increasingly worrying, as indicated by the recent upward surge in incidence of obesity-related glomerulopathy. Such complex disorder affects the kidney leading to glomerular damage, chronic kidney disease, nephrolithiasis, and kidney cancers and demands population-wide interventions since preventive measures are definitely possible. Here, we also analyze the alterations of thyroid hormones, renin-angiotensin-aldosterone system, antidiuretic hormone, parathyroid, and sexual hormones in the setting of chronic kidney disease. The interplay between different endocrine axes is taken into account in light of the clinical changes driven by modifications in renal function.