Nephritis refers to the condition wherein the kidney, specifically the tubules in the kidney, is inflamed resulting in impairment of kidney functions. When our kidneys are not working well and the condition is not treated, trouble in other body parts soon follows. This is because our kidneys are our internal filter mechanism – the kidneys process hundreds of liters of blood every day, filtering our blood and sending clean blood back into the body.
There are two important parts in our kidneys in this filtering mechanism. These are the glomerulus and the tubule. Once the blood cells and protein are filtered by the glomerulus, the rest are then passed on to the tubule which filters for minerals. After the tubule gets all the usable minerals, the rest of the fluids are then expelled from the body as urine.
Male sexual dysfunction, on the other hand, refers to a condition present during any of the phases of sex – desire, arousal, and orgasm – which prevents the man or his partner or both of them from gaining satisfaction during sex. For instance, abnormally low libido is a dysfunction of sexual desire, while erectile dysfunction is an issue with arousal, and premature ejaculation is an orgasm problem.
When nephritis is chronic or acute, sexual dysfunction almost always follows. In fact, chronic kidney disease, which is a result of untreated nephritis, shares pathophysiological causes with some forms of sexual dysfunction. For instance, diabetes and cardiovascular diseases result in abnormalities in hormonal levels and vascular functions, which are both common in chronic kidney disease and sexual dysfunction.
Nephritis deserves a lot of attention specifically because, in 2015, it was part of the top ten leading causes of death in Americans aged 45 and older. Moreover, sexual dysfunction caused by renal diseases is often under-recognized and remain untreated in many renal disease patients. Take a look at how nephritis, chronic kidney disease, and renal diseases affect sexual functioning in men. To put this in perspective, about 70% of men with end-stage renal disease experience erectile dysfunction and around four in ten sexually active men undergoing hemodialysis do not achieve orgasms.
One study found that patients suffering from chronic kidney disease who undergo hemodialysis as part of their treatment show significant changes in the size of their testicles and exhibit testicular stiffness.
Your gonads are your testes, the organs that produce important hormones, as well as your sperm. In male patients with chronic kidney disease, the testes do not function properly, oftentimes leading to low production of testosterone and hypogonadism.
Because the testes are not producing enough testosterone in male patients with chronic kidney disease, sperm production is also affected. This needs special attention because it occurs even during the early stages of kidney diseases, and continue to worsen as the kidney disease also progresses. Ultimately, if the disease is not treated, infertility can result.
One study revealed that when the seminiferous tubules in the kidney get damaged because of chronic kidney disease, it not just leads to negatively impacted testicular functions. It is also associated with testicular atrophy, wherein the testes diminish in size.
The worse the chronic kidney disease gets, the lower your semen volume becomes. This also holds true for your total sperm number and sperm concentration. The fluid that you ejaculate is composed of sperm cells and seminal fluids which help the sperm cells swim. In male patients with chronic kidney disease, however, testosterone levels are quite low because of abnormal gonadal function. This then leads to lesser production of sperm cells and seminal fluid. As a result, the total volume of the ejaculate also decreases.
Low azoospermia refers to a condition wherein there is very little sperm cells contained in the ejaculated fluid. Complete azoospermia means the ejaculated fluid contains absolutely no sperm cells at all. The normal range of semen volume averages between three to five milliliters and only about 10% of this is composed of sperm cells. Semen volume normally varies, especially as men age. But complete azoospermia is definitely abnormal and can lead to infertility. Complete azoospermia can happen if there are obstructions preventing sperm cells from entering the ejaculate. In male patients with chronic kidney disease, complete azoospermia is a result of abnormal testicular function, wherein there is little or no sperm production at all.
In a study involving male uremic patients, the researchers found that levels of sperm motility were much lower when compared to that of healthy men. The same held true for sperm concentration as well as normal sperm morphology rate. Moreover, in healthy men, there were lower numbers of sperm cells with deformity and head defects as compared to the male uremic patients. Uremia, by the way, is a condition wherein components such as creatinine and urea, which are supposed to be expelled from the body through urination, remain in the bloodstream because the kidneys fail to filter them out.
This is one of the end results of the impact of kidney diseases on male sexual functioning. As you have seen, when the kidneys fail, the way your testes function becomes impaired, resulting in low testosterone levels. This then cascades to low sperm and seminal fluid production, in worse cases, even leading to azoospermia. All these ultimately lead to infertility. Coupled with decreased libido and erectile dysfunction, it is obvious that a man with end-stage renal disease can no longer function sexually.
When the glomerulus in the kidneys starts performing poorly, prolactin levels in the body increase. The poorer the glomerulus filters the blood, the higher the prolactin levels rise. Prolactin causes loss of libido and infertility.
It is widely accepted that erectile dysfunction is prevalent in patients with chronic kidney disease, especially those who undergo hemodialysis. There are various factors leading to erectile dysfunction. Among these are decreased arterial blood flow, hormonal disturbances, medication side effects, and altered penile smooth muscle function.