Abstract
Thyroid hormones play an important role in the growth of the kidney and maintenance of its functions. Prolonged hypothyroidism is known to be accompanied by changes in renal morphology such as thickening of the glomerular and tubular basement membranes as well as increased mesangial matrix. Increased transcapillary leakage of plasma proteins leading to proteinuria and generalized edema is also a known complication of hypothyroidism. In particular, autoimmune thyroiditis is associated with proteinuria. Most previous reports of autoimmune thyroiditis with nephrotic syndrome have demonstrated mixed pathological morphology marked by predominant membranous glomerulopathy. Here we present a patient whose initial presentation with profound hypothyroidism and autoimmune thyroiditis was dominated by nephrotic syndrome secondary to type 1 membranoproliferative glomerulonephritis (MPGN). The association of MPGN and autoimmune thyroiditis is very rare.
References
Katz AI, Emmanouel DS, Lindheimer MD (1975) Thyroid hormone and the kidney. Nephron 15:223–249
Tunbridge WM, Vanderpump MP (2000) Population screening for autoimmune thyroid disease. Endocrinol Metab Clin North Am 29:239–253
Agras PI, Kinik ST, Cengiz N, Baskin E, Saatci U (2005) Autoimmune thyroiditis with associated proteinuria: Report of two patients. J Pediatr Endocrinol Metab 18:319–322
Suher M, Koc E, Ata N, Ensari C (2005) Relation of thyroid disfunction, thyroid autoantibodies, and renal function. Ren Fail 27:739–742
Weetman AP, Tomlinson K, Amos N, Lazarus JH, Hall R, McGregor AM (1985) Proteinuria in autoimmune thyroid disease. Acta Endocrinol (Copenh) 109:341–347
Nishimoto A, Tomiyoshi Y, Sakemi T, Kanegae F, Nakamura M, Ikeda Y, Shimazu K, Yonemitzu N (2000) Simultaneous occurrence of minimal change glomerular disease, sarcoidosis and Hashimoto’s thyroiditis. Am J Nephrol 20:425–428
Weetman AP, Pinching AJ, Pussel BA, Evans DJ, Sweny P, Rees AJ (1981) Membranous glomerulonephritis and autoimmune thyroid disease. Clin Nephrol 15:50–51
Enriquez R, Sirvent AE, Amoros F, Andrada E, Cabezuelo JB, Reyes A (2002) IgA nephropathy and autoimmune thyroiditis. Clin Nephrol 57:406–407
Grcevska L, Polenakovic M, Petrusevska G (2000) Membranous nephropathy associated with thyroid disorders. Nephron 86:534–535
Illies F, Wingen AM, Bald M, Hoyer PF (2004) Autoimmune thyroiditis in association with membranous nephropathy. J Pediatr Endocrinol Metab 17:99–104
Jordan SC, Buckingham B, Sakai R, Olson D (1981) Studies of immune-complex glomerulonephritis mediated by human thyroglobulin. N Engl J Med 304:1212–1215
Valentin M, Bueno B, Gutierrez E, Martinez A, Gonzalez E, Espejo B, Torres A (2004) Membranoproliferative glomerulonephritis associated with autoimmune thyroiditis. Nefrologia 3:43–48
Ploth DW, Fitz A, Schnetzler D, Seidenfeld J, Wilson CB (1978) Thyroglobulin-anti-thyroglobulin immune complex glomerulonephritis complicating radioiodine therapy. Clin Immunol Immunopathol 9:327–334
Dizdar O, Kahraman S, Genctoy G, Ertoy D, Arici M, Altun B, Yasavul U, Turgan C (2004) Membranoproliferative glomerulonephritis associated with type 1 diabetes mellitus and hashimoto’s thyroiditis. Nephrol Dial Transplant 19:988–999
Mahjoub S, Ben Dhia N, Achour A, Zebidi A, Frih A, Elmay M (1991) Primary hypothyroidism and glomerular involvement. Ann Endocrinol (Paris) 52:289–292
Jordan SC, Johnston WH, Bergstein JM (1978) Immune complex glomerulonephritis mediated by thyroid antigens. Arch Pathol Lab Med 102:530–533
Sato Y, Sasaki M, Kan R, Osaku A, Koyama S, Shibayama S, Sato M, Narumiya K, Takagi T, Kojima M (1989) Thyroid antigen-mediated glomerulonephritis in graves’ disease. Clin Nephrol 31:49–52
Salomon MI, Di Scala V, Grishman E, Brener J, Churg J (1967) Renal lesions in hypothyroidism: A study based on kidney biopsies. Metabolism 16:846–852
Montenegro J, Gonzalez O, Saracho R, Aguirre R, Gonzalez O, Martinez I (1996) Changes in renal function in primary hypothyroidism. Am J Kidney Dis 27:195–198
Mooraki A, Broumand B, Neekdoost F, Amirmokri P, Bastani B (2003) Reversible acute renal failure associated with hypothyroidism: Report of four cases with a brief review of literature. Nephrology (Carlton) 8:57–60
Lafayette RA, Costa ME, King AJ (1994) Increased serum creatinine in the absence of renal failure in profound hypothyroidism. Am J Med 96:298–299
Singer MA (2001) Of mice and men and elephants: Metabolic rate sets glomerular filtration rate. Am J Kidney Dis 37:164–178
Ford RV, Owens JC, Curd GW Jr, Moyer JH, Spurr CL (1961) Kidney function in various thyroid states. J Clin Endocrinol Metab 21:548–553
Villabona C, Sahun M, Roca M, Mora J, Gomez N, Gomez JM, Puchal R, Soler J (1999) Blood volumes and renal function in overt and subclinical primary hypothyroidism. Am J Med Sci 318:277–280
Derubertis FR Jr, Michelis MF, Bloom ME, Mintz DH, Field JB, Davis BB (1971) Impaired water excretion in myxedema. Am J Med 51:41–53
Shankland SJ (2000) New insights into the pathogenesis of membranous nephropathy. Kidney Int 57:1204–1205
Kerjaschki D (2000) Megalin/GP330 and pathogenetic concepts of membranous glomerulopathy (MGN). Kidney Blood Press Res 23:163–166
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gurkan, S., Dikman, S. & Saland, M.J. A case of autoimmune thyroiditis and membranoproliferative glomerulonephritis. Pediatr Nephrol 24, 193–197 (2009). https://doi.org/10.1007/s00467-007-0668-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-007-0668-y