Year : 2017 | Volume
: 14 | Issue : 2 | Page : 43--44
The kidney and the thyroid – Together in function and disease
Krishna G Seshadri
Editor in Chief, Thyroid Research in Practice, Visiting Professor Endocrinology and Medical Education, Sri Balaji Vidyapeeth, Pondicherry, India
Krishna G Seshadri
Editor in Chief, Thyroid Research in Practice, 175 Brahmputra Street Palaniappa Nagar, Valasaravakkam, Chennai - 600 087, Tamil Nadu
|How to cite this article:|
Seshadri KG. The kidney and the thyroid – Together in function and disease.Thyroid Res Pract 2017;14:43-44
|How to cite this URL:|
Seshadri KG. The kidney and the thyroid – Together in function and disease. Thyroid Res Pract [serial online] 2017 [cited 2020 Dec 1 ];14:43-44
Available from: https://www.thetrp.net/text.asp?2017/14/2/43/207132
The effects of thyroid hormone (TH) on renal development, structure, and function are well documented. Some of these are direct, others due to the effect of systemic hemodynamic changes. Congenital hypothyroidism (CH) is associated with renal dysmorphogenesis possibly related to mutations encoding the transcription factor PAX8. Reduced renal mass is common in patients with CH. Higher prevalence of renal agenesis, dysplasia, ectopy, and other genitourinary abnormalities has been reported.
Varying levels of creatinine elevation, mostly modest but sometimes significant, have been reported in hypothyroidism which are in the most part reversible on therapy. Studies on patients who have undergone thyroidectomy suggest changes in creatinine in hypothyroid patients reflect changes in glomerular filtration rate (GFR). This is attributable to both direct effects of TH on the kidney and indirect effects through action on the heart and vasculature.
In addition to the above, TH has effects on the expression and function of a number of renal ion channels and transporters. Down regulation of aquaporin 1 and 2 in addition to the known hemodynamic changes described in thyrotoxicosis in addition to cause polyuria. Nonosmotic arginine vasopressin release, decreased concentrating capacity, and reversible reduction in sodium reabsorption in proximal and distal tubules may in part cause hyponatremia seen in hypothyroidism.
In this issue of the journal, Gandhi et al. underline another important association between the kidney and thyroid. A few case reports of reversible proteinuria biopsy-proven glomerulonephritis (GN) have been described in both hypo- and hyper-thyroidism. The renal pathology in these patients has varied from membranous nephropathy, minimal change, membranoproliferative GN, and IgA nephropathy. Glomerular disease has been reported after the treatment for hyperthyroidism both medical and ablative.,
In this retrospective analysis of patients referred for the evaluation of proteinuria or hematuria, the authors demonstrated a significant association between hypothyroidism of duration >1 year and proteinuria; nonsignificant associations were seen with nephrotic-range proteinuria and nephrotic syndrome. Serum creatinine elevations (1.09 ± 0.21 vs. 1.38 ± 0.31, P = 0.003) and decreases in GFR (P = 0.04) also correlated with disease duration of >1 year. Biopsy findings were available in 32 of the 36 patients; 50% should membranous nephropathy followed by focal segmental glomerulosclerosis, minimal change disease, and IgA nephropathy in the order of prevalence. Follow-up data were available in 22 patients. Reductions in proteinuria to <1 g/24 h were seen >50% in the membranous GN group who 16 were given standard of care in addition to thyroxine therapy. It is unclear if the improvement seen was due to thyroxine per se.
The coexistence of two autoimmune disorders raises the possibility of autoimmunity as the common thread that explains the association. Indeed, there are reports of thyroid peroxidase (TPO) and thyroglobulin deposits in the kidney. The authors have not reported anti-TPO levels in this study. Despite the numbers and the limitations obvious to the reader, Gandhi et al. provide a timely reminder to the clinician to be vigilant of the important relationship between the thyroid and kidney. The take home would be to consider thyroid dysfunction in unexplained creatinine elevations and electrolyte imbalance. Since it can be reversed. Thyroid dysfunction may be a gratifying find in these circumstances. The relationship between glomerular disease and autoimmune thyroid disease is tenacious but still worth exploring.
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