A Transient Proteinuria: An Unusual Complication of Hypothyroidism (original) (raw)
Related papers
Severe hypothyroidism presenting as reversible proteinuria: two case reports
Journal of Medical Case Reports
Background: Hypothyroidism is a common medical disorder which results in many metabolic effects, such as dyslipidemia, hypertension, accelerated atherosclerosis, and coronary artery disease. Hypothyroidism affects the renal physiology by affecting the renal blood flow, vascular resistance, and sodium handling. Recent studies have shown hypothyroidism is associated with decreased estimated renal function and proteinuria. Rhabdomyolysis and acute renal insufficiency have also been described in association with hypothyroidism. The severity of the proteinuria was directly proportional to thyroid-stimulating hormone levels. Currently, there is a lack of evidence on the reversibility of proteinuria in hypothyroidism. This is the first report in the literature, to the best of our knowledge, demonstrating the reversibility of proteinuria associated with hypothyroidism, with treatment. Case presentation: Here we describe two cases, a 72-year-old Sinhalese man and a 47-year-old Tamil woman, from Sri Lanka, presenting with overt hypothyroidism; they were found to have elevated creatinine, proteinuria, and elevated creatinine kinase levels. Due to lack of active sediment in urine analysis, these patients were observed after the initiation of thyroxine therapy. They were investigated in the adultonset proteinuria pathway, excluding common reasons for proteinuria. Both patients responded to treatment: their serum creatinine, creatinine kinase, and urine protein levels reverted to physiological levels within 6 months of treatment with thyroxine, and with normalization of thyroid-stimulating hormone. Conclusion: Hypothyroidism can present as renal insufficiency, proteinuria, and can mimic rhabdomyolysis. Prompt initiation of thyroxine treatment and control of thyroid-stimulating hormone levels could reverse these changes.
Proteinuria in severe hypothyroidism: A prospective study.
J Clin Endocrinol Metab, 2020
Context: Hypothyroidism is associated with reversible decline in kidney function as measured by estimated glomerular filtration rate (eGFR). eGFR and proteinuria are most important markers for clinical assessment of kidney function. Though hypothyroidism is associated with proteinuria in cross sectional data, the impact of treatment on proteinuria is unknown. Objective: The study explores the effect of thyroid hormone replacement therapy on eGFR and 24-hour urine protein excretion in patients with severe primary hypothyroidism. Design and participants: The study was a prospective, observational cohort study in adult subjects with severe primary hypothyroidism (serum TSH >50 µIU/mL). Subjects with pre-existing or past kidney disease, kidney or urinary tract abnormalities, calculi or surgery, diabetes mellitus or hypertension were excluded. The participants received thyroid hormone replacement therapy. Thyroid functions, eGFR, 24-hour urine protein excretion and biochemical parameters were measured at baseline and 3 months. Setting: Single center, tertiary care referral and teaching hospital. Results: Out of 44 enrolled participants, 43 completed 3 months of follow up. At 3 months, serum TSH levels decreased and T4 levels increased (p<0.001 for both). Significant increase in eGFR (mean difference: 18.25±19.49ml/min/1.73m 2, 95% CI: 12.25 to 24.25, p<0.001) and decline in 24-hour urine protein excretion (mean difference: -68.39±125.89 mg/day, 95% CI: -107.14 to -29.65, p=0.001) were observed. Serum cholesterol and LDL levels also significantly decreased (p<0.001). Conclusions: Thyroid hormone replacement therapy in patients with severe primary hypothyroidism improves eGFR and decreases 24-hour urine protein excretion, thereby suggesting reversible alterations.
Hypothyroidism presenting as reversible renal impairment: an interesting case report
Renal Failure, 2013
We describe an interesting case of reversible renal impairment secondary to hypothyroidism. A 57-years-old man was referred from peripheral institution for evaluation of elevated serum creatinine. He had vague complaints of weakness, lethargy and muscle ache but no urinary symptoms. He was found to have hypothyroidism, and thyroid hormone replacement therapy (THRT) was started which resulted in reversal of the renal dysfunction. There was marked improvement in estimated glomerular filtration rate. 99mTc DTPA renal scans done before and after THRT suggested hypothyroidism responsible for this reversible renal impairment. Several studies have described the pathophysiology of diminished renal function in hypothyroidism. Few studies or case reports have shown total amelioration of renal impairment as seen in our patient. The etiology is presumed to be multifactorial, in which hemodynamic effects and a direct effect of thyroid hormone on the kidney play an important role. We suggest that patients with renal impairment of unknown cause have thyroid function tests undertaken as part of routine investigation.
Reversal deterioration of renal function accompanied with primary hypothyrodism
Vojnosanitetski pregled. Military-medical and pharmaceutical review, 2012
Hypothyroidism is often accompanied with decline of kidney function, or inability to maintain electrolyte balance. These changes are usually overlooked in everyday practice. Early recognition of this association eliminates unnecessary diagnostic procedures that postpone the adequate treatment. Two patients with elevated serum creatinine levels due to primary autoimmune hypothyroidism, with complete recovery of creatinine clearance after thyroid hormone substitution therapy are presented. The first patient was a young male whose laboratory tests suggested acute renal failure, and the delicate clinical presentation of reduced thyroid function. The second patient was an elderly woman with a history of a long-term signs and symptoms attributed to ageing, including the deterioration of renal function, with consequently delayed diagnosis of hypothyroidism. Serum thyrotropin and thyroxin levels measurement should be done in all cases of renal failure with undefined renal desease, even if t...
The Egyptian Journal of Hospital Medicine
Background: Emerging evidence shows a bi-directional talk between the kidney and thyroid; yet to date, sparse data exist as to the screening and treatment of hypothyroid states, whether Subclinical Hypothyroidism (SCH) or Clinical Hypothyroidism (CHT), in Chronic Kidney Disease (CKD) patients. Objectives: The aim of the current study was to examine the association between thyroid hypofunction (whether subclinical or clinical) and proteinuric CKD (low eGFR and/or proteinuria), and to assess the impact of treating thyroid hypofunction on the progression of CKD. Patients and methods: We conducted a prospective cohort study on 100 participants with baseline proteinuric CKD who were subcategorized according to their thyroid status into three groups: 20 euthyroid, 40 (SCH), 40 (CHT). All subjects were then followed up for 2 years after receiving Thyroid Hormone Replacement Therapy (THRT) according to their thyroid status. Results: At baseline, we found a highly statistically significant association between SCH/CHT and low eGFR and proteinuria (P-value < 0.001 for both) in univariate and multivariate analyses. After THRT, we found a statistically significant reduction in CKD progression as evidenced by preservation of mean eGFR and decrease in proteinuria in both groups with SCH and CHT (P-value < 0.001 and 0.016 respectively) after the first 6 months of treatment that persisted over the remainder of 2-year follow-up period at a P-value <0.001. Conclusion: The current study demonstrated a strong association between baseline proteinuric CKD and hypothyroid states and showed that THRT significantly halted CKD progression in hypothyroid patients who achieved euthyroid state.
Kidney failure in the elderly due to hypothyroidism: a case report
Sao Paulo Medical Journal, 2008
CONTEXT: Hypothyroidism is more prevalent in the elderly and its symptoms can be confused with other changes due to aging. Doctors caring for the elderly need to be attentive to this diagnostic possibility. This case report case is notable not only because it presents a rare complication of hypothyroidism (kidney failure), but also because patients with chronic kidney failure of any etiology may suffer increased renal dysfunction as a result. CASE REPORT: This was a 66-year-old male outpatient with a history of generalized edema over the preceding eight years, with periods of worsening, that was intractable to treatment with diuretics. Physical examination revealed bradycardia (heart rate: 52 bpm), pallor, dry and infiltrated skin, macroglossia, edema in the lower limbs and a palpable thyroid with hard consistency. Laboratory tests showed: creatinine 3.9 mg/dl; urea 95 mg/dl; potassium 6.0 mEq/l; thyroid-stimulating hormone > 100 mUI/ml; triiodothyronine 0.01 ng/dl; free thyroxin...
Hypothyroidism Complicating Nephropathy in a Diabetes Patient
Case Reports in …, 2012
We describe a patient with type 2 diabetes mellitus and autoimmune hypothyroidism who presented with elevated serum creatinine possibly due to subclinical rhabdomyolysis induced by hypolipidemic drug therapy in the background of diabetic nephropathy. Both hypothyroidism and rhabdomyolysis were asymptomatic in this case as evidenced by lack of classical clinical features of hypothyroidism despite elevated serum TSH and absent pigment cast in renal biopsy. The combination of diabetes mellitus and hypothyroidism is common in the general population and should not be forgotten in patients with diabetes and kidney disease.