Skip to main content

Advertisement

SpringerLink
Log in

Thyroid function in patients with idiopathic nephrotic syndrome

  • Nephrology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Background

Albumin is the major protein excreted in urine in patients with nephrotic syndrome (NS). However, low-molecular-weight proteins including some binding proteins are also excreted. Thyroid hormone and its binding globulins are excreted in urine in excess in nephrotic syndrome. Therefore, it has been postulated that patients with nephrotic syndrome may show hypothyroidism, subclinical or overt.

Methods

In this prospective observational study, patients of idiopathic nephrotic syndrome aged 1–40 years of both gender were included. Serum T3, T4 and TSH were assayed at diagnosis and repeated at 12 weeks or at remission whichever was earlier. Renal biopsy was performed as required.

Results

Among 100 patients taken for analysis (42 children, 58 adult), 30 cases were of first episode, 40 were of frequent relapse/steroid-dependent NS, and 30 patients had steroid-resistant NS (SRNS). Three (3%) cases had overt hypothyroidism and 18 (18%) patients had subclinical hypothyroidism. Most hypothyroid cases belonged to SRNS subgroup. Mean Serum T3, T4 and TSH values showed significant improvement in remission in comparison to nephrosis state (P < 0.01). Serum TSH had significant positive correlation (r = 0.391, P < 0.01) with 24-h proteinuria and negative correlation with serum albumin (r =  − 0.303, P < 0.01) in nephrosis.

Conclusion

Hypothyroidism is common among nephrotic syndrome patients especially in SRNS subgroup. Therefore, routine screening is recommended in steroid-resistant nephrotic syndrome patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Banh TH, Hussain-Shamsy N, Patel V et al (2016) Ethnic differences in incidence and outcomes of childhood nephrotic syndrome. Clin J Am Soc Nephrol 11:1760–1768

    Article  CAS  Google Scholar 

  2. Chanchlani R, Parekh RS (2016) Ethnic differences in childhood nephrotic syndrome. Front Pediatr 4:39

    Article  Google Scholar 

  3. Kodner C (2016) Diagnosis and management of nephrotic syndrome in adults. Am Fam Physician 93(6):479–485

    PubMed  Google Scholar 

  4. Allison AE, Jordan MS (2003) Nephrotic syndrome in childhood. Lancet 362:629–639

    Article  Google Scholar 

  5. Gilles R, den Heijer M, Ross AH, Sweep FC, Hermus AR, Wetzels JF (2008) Thyroid function in patients with proteinuria. Netherlands J Med 66(11):483–485

    CAS  Google Scholar 

  6. Marimuthu M, Krishnamuuthy S, Rajappa M (2017) Non-autoimmune subclinical and overt hypothyroidism in idiopathic steroid-resistant nephrotic syndrome in children. Ind Ped 54:925–929

    Google Scholar 

  7. Garber JR, Cobin RH, Gharib H et al (2012) Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid 22:1200

    Article  CAS  Google Scholar 

  8. Shriram M, Sridhar M (2014) Subclinical hypothyroidism in children. Indian Pediatr 51:889

    Article  Google Scholar 

  9. Holmberg C, Antikainen M, Rönnholm K, Ala-Houhala M, Jalanko H (1995) Management of the congenital nephrotic syndrome of the Finnish type. Pediatr Nephrol 9:87–93

    Article  CAS  Google Scholar 

  10. Kidney Disease: Improving Global Outcomes (KDIGO) Glomeru- lonephritis Work Group (2012) KDIGO clinical practice guideline for glomerulonephritis. Kidney Inter Suppl 2:139–274

    Article  Google Scholar 

  11. Dugaw KA, Jack RM, Rutledge J (2001) Pediatric reference ranges for TSH, free T4, total T4, total T3 and T3 uptake the Vitros ECI analyser. Clin Chem 47:A108

    Google Scholar 

  12. Abbasi- Ghanavati M, Greer LG, Cunningham FG (2009) Pregnancy and laboratory studies a reference table for clinicians. Obstet Gynecol 114:1326–1331

    Article  Google Scholar 

  13. Hay ID, Klee GG (1993) Linking medical needs and performance goals: clinical and laboratory perspectives on thyroid disease. Clin Chem 39:1519–1524

    Article  CAS  Google Scholar 

  14. Rugge JB, Bougatsos C, Chou R (2015) Screening and treatment of thyroid dysfunction: an evidence review for the U.S. preventive services task force. Ann Intern Med 162:35–45

    Article  Google Scholar 

  15. Rapa A, Monzani A, Moia S, Bellone S, Petri A, Teofoli F et al (2009) Subclinical hypothyroidism in children and adolescents: a wide range of clinical, biochemical, and genetic factors involved. J Clin Endocrinol Metab 94:2414–2420

    Article  CAS  Google Scholar 

  16. Sharma S et al (2015) Evaluation of thyroid hormone status in children with steroid resistant nephrotic syndrome: a north India study. Endocr Metab Immune Disord Drug Targets 15:4

    Article  Google Scholar 

  17. Kapoor K, Saha A, Dubey NK (2014) Subclinical non autoimmune hypothyroidism in children with steroid resistant nephritic syndrome. Clin Exp Nephrol 18(1):113–117

    Article  CAS  Google Scholar 

  18. Karethimmaiah H, Sarathi V (2016) Abnormalities of thyroid function tests in adult patients with nephrotic syndrome. Int J Res Med Sci 4(10):4300–4304

    Article  Google Scholar 

  19. Jain D, Aggarwal HK, Kumar YMP, Jain P (2019) Evaluation of thyroid dysfunction in patients with nephrotic syndrome. Med and Pharm Reports 92(2):139–144

    Google Scholar 

  20. Gurkan S, Dikman S, Saland MJ (2009) A case of autoimmune thyroiditis and membranoproliferative glomerulonephritis. Pediatric Nephrol 24(1):193–197. https://doi.org/10.1007/s00467-007-0668-y

    Article  Google Scholar 

  21. Grcevska L, Polenakovic M, Petrusevska G (2000) Membranous nephropathy associated with thyroid disorders. Nephron 86:534–535

    Article  CAS  Google Scholar 

  22. Enríquez R, Sirvent AE, Amorós F, Andrada E, Cabezuelo JB, Reyes A (2002) IgA nephropathy and autoimmune thyroiditis. Clin Nephrol 57:406–407

    PubMed  Google Scholar 

  23. Iglesias P, Diez JJ (2009) Thyroid dysfunction and kidney disease. Eur J Endocrinol 160:503–515

    Article  CAS  Google Scholar 

  24. Feinstein EI, Kaptein EM, Nicoloff JT, Massry SG (1982) Thyroid function in patients with nephrotic syndrome and normal renal function. Am J Nephrol 2:70–76

    Article  CAS  Google Scholar 

  25. Junglee NA, Scanlon MF, Rees DA (2006) Increasing thyroxine requirements in primary hypothyroidism: don’t forget the urinalysis! J Postgrad Med 52:201–203

    CAS  PubMed  Google Scholar 

  26. Choudhury J (2016) A study on thyroid function test in children with nephrotic syndrome. Int J Contemp Pediatr 3(3):752–754

    Article  Google Scholar 

  27. Sahni V, Nanda S, Gehlawat VK, Gathwala G (2014) Hypothyroidism in nephrotic syndrome in children. IOSR J Dent Med Sci 13(8):07–11

    Article  Google Scholar 

  28. Unal E, Akın A, Yıldırım R et al (2017) Association of subclinical hypothyroidism with dyslipidemia and increased carotid intima-media thickness in children. J Clin Res Pediatr Endocrinol 9:144

    Article  Google Scholar 

Download references

Acknowledgements

SS and OPM were consultant in charge. OPM, PPM and SS conceived the idea. PPM collected the data. PPM, PSP and SSS took part in histopathological and statistical analysis. PPM, HS and KR drafted the manuscript. SS and OPM crucially reviewed the manuscript.

Author information

Authors and Affiliations

  1. Department of Nephrology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India

    Shivendra Singh, Partha Pratim Mandal, Prem Shankar Patel, Shiv Shankar Sharma, Harish Saini, Khushboo Rani, Sreenidhi Chandrasekhar & Manjit Pal Singh

  2. Division of Pediatric Nephrology, Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India

    Om Prakash Mishra

Authors
  1. Shivendra Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Om Prakash Mishra
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Partha Pratim Mandal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Prem Shankar Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shiv Shankar Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Harish Saini
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Khushboo Rani
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sreenidhi Chandrasekhar
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Manjit Pal Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Partha Pratim Mandal.

Ethics declarations

Conflict of interest

The authors have declared that no conflict of interest exists.

Human and animal rights: ethical approval

All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (IRB approval number Dean/2018/EC/349 dated 02/01/2018) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants/their parents included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Singh, S., Mishra, O.P., Mandal, P.P. et al. Thyroid function in patients with idiopathic nephrotic syndrome. Int Urol Nephrol 53, 1859–1864 (2021). https://doi.org/10.1007/s11255-020-02778-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-020-02778-3

Keywords

Search

Navigation