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5 Referral of the patient to a nephrologist is important, as complications such as volume overload, anaemia, electrolyte imbalances and CKD-related mineral and bone disorders can become prominent management issues when the eGFR declines to below the cut-off

Baseline testing should include total testosterone measured in the morning (between 7-11 AM when levels are highest), and if low, confirmatory repeat testing on a separate day along with luteinizing hormone (LH), follicle-stimulating hormone (FSH), and prolactin to characterize the type of hypogonadism

Once the patient demonstrates good tolerability, topiramate is added in a low dose, commonly 25 mg at night or 25 mg twice daily, depending on clinical judgment and patient response

Macrophages suppress T cell responses and arthritis development in mice by producing reactive oxygen species