The relationship between thyroid dysfunction and nephrotic syndrome: a clinicopathological study

Abstract

Abnormalities of thyroid function are common in patients with nephrotic syndrome (NS). However, a limited number of studies have reported on the association between clinicopathologic features and thyroid dysfunction in patients with NS. We retrospectively studied 317 patients who had been definitively diagnosed with NS. The NS patients with thyroid dysfunction showed higher urine protein, creatinine and lipid levels and lower albumin and hemoglobin than those with normal thyroid function, with no significant differences of pathological types. After dividing thyroid dysfunction groups into five subgroups, interestingly, membranous nephropathy was the most common pathologic type, both in normal thyroid group and in subclinical hypothyroidism group (40.4% and 46.7%, respectively), followed by minimal change disease (28.1% and 21.7%, respectively); while in the hypothyroid, low T3, and low T3T4 groups minimal change disease is now the leading type (48.8%, 33.3% and 38.6%, respectively). High levels of urinary protein, creatinine, cholesterol, and platelets were independent risk factors predicting thyroid dysfunction, while higher albumin and hemoglobin were protective factors. We demonstrated that the type of renal pathology was different among NS patients in different thyroid dysfunction subgroups. Interpretation of the interactions between thyroid and renal function is a challenge for clinicians involved in the treatment of patients with NS.

Membranous nephropathy associated with profound hypothyroidism

“…4 Li et al reviewed 317 patients with nephrotic syndrome and found that the most common renal pathology in patients with hypothyroidism was membranous nephropathy followed by minimal change disease. 5 While autoimmune pathways have been proposed as potential mechanisms underlying this association, so far, no precise antibody has been identified. 2,6 Interestingly, we did not find any autoimmune cause for profound hypothyroidism in our patient while he presented with secondary MN.…”

“…Thyroid disease has previously been reported to have a link with development of glomerulonephritis . Li et al reviewed 317 patients with nephrotic syndrome and found that the most common renal pathology in patients with hypothyroidism was membranous nephropathy followed by minimal change disease . While autoimmune pathways have been proposed as potential mechanisms underlying this association, so far, no precise antibody has been identified .…”

Protein energy-wasting associated with nephrotic syndrome – the comparison of metabolic pattern in severe nephrosis to different stages of chronic kidney disease

“…Similar to PEW in CKD, nephrotic syndrome associated PEW is associated with an acceleration in atherosclerosis development, even in children [32]. Not only sarcopenia contributes to it, but also lipid disorders, increased activation of platelets, hypercoagulability, associated hormonal disorders, progressive renal failure [33][34][35][36][37]. Moreover, as we have discovered, hyperphosphatemia and hyperuricemia, recognized independent risk factors of cardiovascular events, were present in patients with severe NS [38][39][40].…”

Identification of Protein Changes in The Urine of Hypothyroid Patients Treated with Thyroxine Using Proteomics Approach

“…The consequent proteinuria often precedes the reduction in GFR in hypothyroidism. Conversely patients with chronic kidney disease (CKD) and those with nephrotic syndrome are also known to present with hypothyroidism and/or subclinical hypothyroidism [2,3].…”

“…In healthy individuals it has shown that 70% of the urinary proteins originate from the kidney and the urinary tract, whereas the remaining 30% represents proteins filtered by the glomerulus [4]. Being an ultrafiltrate of the plasma, the urine is less complex than plasma and a more appropriate biological fluid to study pathological processes arising from either the kidney, urogenital tract and even from systemic diseases [2,3]. This is also seen in cases of different systemic diseases in which proteolytic fragments generated from small circulating proteins peptides and vesicles pass through the glomerulus and change the urinary proteome.…”