Kidney disease and thyroid dysfunction: the chicken or egg problem

Echterdiek, Fabian; Ranke, Michael B.; Schwenger, Vedat; Heemann, Uwe; Latus, Joerg

doi:10.1007/s00467-022-05640-z

Cited by 11 publications

(9 citation statements)

References 87 publications

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“…Second, the conversion of T4 to T3 is inhibited, and iodine clearance is also impaired. Finally, metabolic acidosis, inflammatory status, and diet are factors to consider ( 21 , 22 ). The epidemiology of MN shows that it is more common in middle-aged and elderly people, with a 2:1 male predominance ( 3 ).…”

Section: Discussionmentioning

confidence: 99%

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Clinicopathological features and prognosis of idiopathic membranous nephropathy with thyroid dysfunction

Wang

Huang

et al. 2023

Front. Endocrinol.

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BackgroundThyroid dysfunction is common in patients with kidney disease. However, the relationship between thyroid dysfunction and idiopathic membranous nephropathy (IMN) remains unclear. This retrospective study aimed to investigate the clinicopathological characteristics and prognosis of patients with IMN and thyroid dysfunction compared to patients with IMN and without thyroid dysfunction.MethodsA total of 1052 patients with IMN diagnosed by renal biopsy were enrolled in this study, including 736 (70%) with normal thyroid function and 316 (30%) with abnormal thyroid function. We analyzed the clinicopathological features and prognostic data between the two groups, using propensity score matching (PSM) to reduce the bias. Logistic regression analysis was performed to investigate the risk factors for IMN combined with thyroid dysfunction. Kaplan-Meier curves and Cox regression analysis were used to evaluate the association between thyroid dysfunction and IMN.ResultsPatients with IMN and thyroid dysfunction exhibited more severe clinical features. Female sex, lower albumin level, higher D-dimer level, severe proteinuria, and decreased estimated glomerular filtration rate were predictors of thyroid dysfunction in patients with IMN. After PSM, 282 pairs were successfully matched. Results from the Kaplan-Meier curves indicated that the thyroid dysfunction group had a lower complete remission rate (P = 0.044), higher relapse rate (P < 0.001), and lower renal survival rate (P = 0.004). The multivariate Cox regression analysis revealed that thyroid dysfunction was an independent risk factor for complete remission [hazard ratio (HR) = 0.810, P = 0.045], relapse (HR = 1.721, P = 0.001), and composite endpoint event (HR = 2.113, P = 0.014) in IMN.ConclusionsThyroid dysfunction is relatively common in patients with IMN, and the clinical indicators are more severe in these patients. Thyroid dysfunction is an independent risk factor for poor prognosis in patients with IMN. More attention should be paid to thyroid function in patients with IMN.

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Section: Discussionmentioning

confidence: 99%

“…Thyroid dysfunction affects kidney function in several ways ( 21 , 22 ). First, it can damage the renal structure, resulting in decreased kidney volume, thickened glomerular basement membrane, increased mesangial matrix, and capillary permeability.…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological features and prognosis of idiopathic membranous nephropathy with thyroid dysfunction

Wang

Huang

et al. 2023

Front. Endocrinol.

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“…Consequently, there is an increase in the concentrations of Na + and Cl − in distal renal tubules, leading to enhanced tubule feedback and subsequent reductions in RBF and GFR. 11 Additionally, decreased TH directly affects the synthesis and secretion of the renin-angiotensin-aldosterone system (RAAS), thereby diminishing self-regulation of renal perfusion. 12 Furthermore, reduced TH levels exacerbate renal vasoconstriction through the indirect effects mediated by paracrine or endocrine factors like insulin-like growth factor 1 (IGF-1) and vascular endothelial cell growth factor (VEGF).…”

Section: Pituitary-thyroid Axismentioning

confidence: 99%

Uric Acid Metabolic Disorders in Pituitary-Target Gland Axis

Li,

Wu,

Han

et al. 2024

DMSO

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Uric acid (UA) is the end product of purine metabolism in the human, and the imbalance between production and excretion results in the disturbance of serum uric acid (SUA). There is evidence suggesting that pituitary-target gland hormones can affect UA metabolism through regulating the activity of xanthine oxidase and UA transporters. Related endocrine diseases including thyroid dysfunction, polycystic ovary syndrome, acromegaly and Cushing's syndrome are often accompanied by elevated UA levels. In addition to the direct influence of abnormal hormones, obesity and insulin resistant play a pivotal role. Diabetes insipidus and the syndrome of inappropriate antidiuretic hormone secretion also present with abnormal SUA levels due to the action of antidiuretic hormone. However, certain evidence within the population is disputed. This review summarized the effects of pituitary-target gland hormones on UA metabolism, and preliminarily described the related mechanisms, offering a theoretical foundation for assessing SUA in endocrine disorders as well as guiding its management.

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“…These ndings are currently fragmentary information, while massive proteinuria and hypothyroidism appear to in uence renal and cholesterol dysregulation. Moreover, initiation of thyroid replacement therapy in CKD patients with SCH may potentially improve kidney function and reduce mortality [11]. Pilot clinical trial in patients with advanced proteinuric CKD and SCH demonstrated that administering levothyroxine (LVX) decreased proteinuria and improved eGFR [12].…”

Section: Introductionmentioning

confidence: 99%

Relationship of thyroid function with renal hemodynamics and cholesterol metabolism in proteinuric kidney disease: A retrospective pilot study

Iwazu

Kotani

Sugase

et al. 2023

Preprint

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Back ground. Massive proteinuria and hypothyroidism are respectively reported to influence renal hemodynamic and hypercholesterolemia. However, the relationship of proteinuria-associated thyroid function with renal hemodynamics and cholesterol metabolism has yet to be determined in a simultaneous analysis of thyroid, renal and cholesterol variables. We investigated the hypothesis that the changes in thyroid hormones by proteinuria may contribute to changes in lipid metabolism and renal hemodynamics by proteinuria. Methods. Twenty-nine patients (17 men) with proteinuric kidney disease (mean age 46 years) were enrolled in a pilot study. Data for serum free triiodothyronine (FT3), free thyroxine (FT4), total cholesterol, and filtration fraction (FF; assessed by para-aminohippuric acid clearance) were used in variable-adjusted correlation analyses. Results. The patients had the following data (mean ± standard deviation): urinary protein 5.18 ± 3.28 g/day, FT3 2.18 ± 0.44 pg/mL, FT4 1.03 ± 0.26 ng/dL, FF 0.27 ± 0.07, and total cholesterol 327 ± 127 mg/dL. There was a significant positive correlation of FT3 with FF (β = 0.58, P = 0.01) and a significant inverse correlation of FT4 with total cholesterol (β = -0.40, P = 0.01). Conclusions. The proteinuria associated reduction in serum thyroid hormone levels may be involved in a part of hypercholesterolemia and the impaired glomerular function due to massive proteinruia. Further studies of these relationships are required.

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Kidney disease and thyroid dysfunction: the chicken or egg problem

Cited by 11 publications

References 87 publications

Clinicopathological features and prognosis of idiopathic membranous nephropathy with thyroid dysfunction

Clinicopathological features and prognosis of idiopathic membranous nephropathy with thyroid dysfunction

Uric Acid Metabolic Disorders in Pituitary-Target Gland Axis

Relationship of thyroid function with renal hemodynamics and cholesterol metabolism in proteinuric kidney disease: A retrospective pilot study

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