Significance of thyroid dysfunction in the patients with primary membranous nephropathy

Abstract

Background Thyroid dysfunction is common in patients with nephrotic syndrome, especially patients with primary membranous nephropathy (pMN). In view of both MN and thyroid dysfunction are associated with autoimmunity, the current study aimed to elucidate the significance of thyroid dysfunction in patients with pMN. Methods Four hundred and twenty patients with biopsy-proven pMN from 2018–2021 were retrospectively enrolled. Clinical and pathological parameters, and treatment response of patients with and without thyroid dysfunction were analyzed. Results Ninety-one (21.7%) patients with pMN suffered from thyroid dysfunction, among which subclinical hypothyroidism (52.7%) was the main disorder. Compared to patients with normal thyroid function, patients with thyroid dysfunction presented with a higher level of proteinuria, a lower level of serum albumin, a higher level of serum creatinine and more severe tubulointerstitial injury at the time of biopsy. But the positive rate and level of circulating anti-phospholipase A2 receptor (PLA2R) antibody were comparable between these two groups. Though following the similar treatment, the percentage of no response to treatment were significantly higher in the patients with thyroid dysfunction (38.6 vs. 20.0%, P = 0.003). Similar to the urinary protein and the positivity of anti-PLA2R antibody, multivariate COX analysis showed thyroid dysfunction was also identified as an independent risk factor for the failure to remission (HR = 1.91, 95%CI, 1.07–3.40, P = 0.029). Conclusion In conclusion, thyroid dysfunction is common in the patients with pMN and might predict a severe clinical manifestation and a poor clinical outcome, which indicated that the thyroid dysfunction might be involved in the disease progression of pMN.

Integrative profiling of untreated primary membranous nephropathy at the single-cell transcriptome level

“…All the patients had circulating anti-PLA2R antibody (Table 1 ) and were also positive for PLA2R in kidney tissue ( Supplementary data, Fig. S1D ), which were detected according to the description in our previous study [ 18 ]. Secondary factors that potentially induce MN were excluded according to patients’ history, thus the patients in present study could be recognized as PLA2R-associated PMN.…”

“…Pathological diagnosis was obtained according to the manifestations on immunofluorescence, light and electron microscopy ( Supplementary data, Fig. S1 ), according to the standard procedure in our hospital [ 18 ]. Clinical and pathological parameters were routinely documented at enrollment.…”

Actualización del tratamiento de la glomerulonefritis membranosa primaria

“…La investigación realizada por Wang et al (2022), en 94 pacientes con nefropatía membranosa idiopática encontró, que con niveles de anticuerpos anti-PLA2R superiores a 150 RU/mL al momento del diagnóstico mostraron una respuesta terapéutica desfavorable al tratamiento basado en tacrolimus. De la misma forma Gu et al (2022), encontró en pacientes desde 2018 a 2021 que la disfunción tiroidea es común en pacientes con nefropatía membranosa primaria afectando al 21.7% de los pacientes. La disfunción tiroidea se identificó como un factor de riesgo independiente para el fracaso de la remisión de la enfermedad.…”