Glomerular filtration rate in patients with Cushing’s disease: a matched case–control study

Abstract

Background: Patients with Cushing's disease have a high prevalence of atherosclerosis and maintain an increased cardiovascular risk even after cure of the disease. However, the impact of Cushing's disease on renal function remains to be quantified. Objectives: To evaluate glomerular filtration rate (GFR) and to identify predictors of GFR in patients with Cushing's disease. Design and methods: We conducted a matched case -control study: 18 patients with active or cured Cushing's disease were compared with healthy population controls matched for age and sex. The main outcome measures were GFR and micro-albuminuria. Results: Patients with Cushing's disease had a lower GFR, as measured by 24-h creatinine clearance (79 versus 95 ml/min per 1.73 m 2 , P ¼ 0.005) and estimated by the MDRD 2 formula (75 versus 88 ml/min per 1.73 m 2 , P ¼ 0.008). Multiple regression analyses indicated that disease duration was the strongest predictor for a worse GFR. The prevalence of micro-albuminuria was low (5.5% in both groups). Conclusions: Patients with Cushing's disease have a decreased GFR. Even if they are cured, close follow-up with strict control of cardiovascular risk factors and monitoring of GFR seems mandatory. Furthermore, the dosage of certain drugs should be adapted to the individual GFR.

Association Between Serum Cortisol and Chronic Kidney Disease in Patients with Essential Hypertension

“…The results showed that patients with Cushing's disease had lower GFR, which measured by 24-h creatinine clearance [8]. On the other hand, cortisol might perform a direct effect on cystatin C and creatinine [12,13].…”

“…Firstly, it has been confirmed that acute effects of cortisol increases the GFR in animals and humans [16,26], while long-term effects of cortisol excess could be totally different [7,8]. Secondly, as serum creatinine or cystatin C levels was influenced by many factors such as muscular atrophy and obesity, using equation that combined creatinine-cystatin C to calculate eGFR was more accurate than singly use creatinine or cystatin C [11].…”

“…Cortisol excess is known to be associated with hypertension in conditions such as Cushing's syndrome [6][7][8].…”

“…It was suggested that cortisol might influence the renal function directly by its effects on glomerular and tubular function [7]. Data showed that acute effects of exogenous cortisol increased the GFR in animals and humans, while long-term effects of excessive endogenous cortisol in humans may decreased GFR [7,8]. Whether serum cortisol correlated to CKD remains unknown.…”

Endocrine Hypertension and Chronic Kidney Disease

“…Reports on proteinuria in people with naturally occurring CS are very rare, but one study described increased urinary albumin excretion in more than 80 % of patients before treatment, which was almost completely resolved after successful therapy [184]. This finding was corroborated in a second report, which mainly involved cured subjects without an increase in microalbuminuria [164]. In general, renal proteinuria may be caused by increased glomerular filtration resulting from higher intraglomerular pressure, damage to the glomerular barrier, or decreased tubular reabsorption [185].…”