Abstract :
Introduction: CKD is a clinical syndrome which occurs due to irreversible loss of renal function leading to metabolic, endocrine, excretory and synthetic function resulting in accumulation of non – protein nitrogenous substances which leads to metabolic derangements and ends up with distinct clinical manifestations.
Aim: To study thyroid function abnormalities in patients with chronic kidney disease. To correlate the thyroid function abnormalities with severity of renal failure. To differentiate primary hypothyroidism from thyroid dysfunction due to chronic kidney disease.
Methodology: After selection of patients, fulfilling the above criteria, about 5 ml of blood sample is collected in non-heparinised serum bottle and sent for thyroid profile test. Components of thyroid profile included in our study and Quantitative determination of T3, T4 and TSH is done by Enzyme Linked Immunosorbent Assay.
Result: In our study out of 50 patients, 33 patients had low serum T3 levels . 4 patients among low serum T3 value, they also had low T4 and high TSH suggesting primary hypothyroidism. So excluding 4 patients of hypothyroidism 29 patients had low T3 syndrome in our study. Low T4 levels in our study, out of which 4 patients had low T3 and high TSH suggesting primary hypothyroidism.
Conclusion: In my study population, 50 CKD patients who were on conservative management were studied. Among them 66% of the patients had low T3 values. The change in the serum levels of T3 and T4 in patients with CKD can be considered as being protective, promoting conservation of protein. There is increase in incidence of hypothyroidism in patients with chronic kidney disease.
Keywords :
Chronic Kidney Disease, Glomerular Filtration Rate, Thyroid Stimulating HormoneReferences :
- Katz AI, Lindheimer MD. Renal sodium- and potassium-activated adenosine triphosphatase and sodium reabsorption in the hypothyroid rat. J Clin Invest. 1973;52:796–804.
- McCaffrey C, Quamme GA. Effects of thyroid status on renal calcium and magnesium handling. Can J Comp Med. 1984;48:51–7.
- Pracyk JB, Slotkin TA. Thyroid hormone differentially regulates development of beta-adrenergic receptors, adenylatecyclase and ornithine decarboxylase in rat heart and kidney. J Dev Physiol. 1991;16:251–61.
- Vaamonde CA, Sebastianelli MJ, Vaamonde LS, Pellegrini EL, Watts RS, Klingler EL, Jr, et al. Impaired renal tubular reabsorption of sodium in hypothyroid man. J Lab Clin Med. 1975;85:451–66.
- Kayima JK et al, (1992). Thyroid hormones profile in patients with chronic renal failure on conservative management and regular hemodialysis. East Afr Med J, 69:333 –
- Robert W Schrier. Abnormalities in the thyroid gland and hypothalamo pituitary thyroid axis in patients with CKD – Diseases of the kidney and urinary tract, eighth edition 2007; volume 3: page number
- P Iglesias and J J Di´Ez. Thyroid dysfunction and kidney disease. European Journal of Endocrinology (2009) 160: 503-515.
- Sang Heon Song, IhmSoo Kwak, Dong Won Lee, Yang Ho Kang, Eun Young Seong and Jin Sup Park. The prevalence of low triiodothyronine according to the stage of chronic kidney disease in subjects with a normal thyroid- stimulating hormone. Nephrol Dial Transplant (2009) 24: 1534– 1538
- Joanne M.Bargman, Karl S.Korecki. Chronic kidney disease. In: Dan L.Lango, Anthony S.Fauci, Dennis Kasper et al. Harrison’s Principles of Internal Medicine, Vol. 2, 18th edn., 2011; McGraw Hill, USA, pp. 2289-2293; 2308- 2313
- Custro N et al. Prospective study on thyroid function anomalies in seriously ill patient. Ann Ital Med Mt, 1992; 7:13-8.
- Weissel M et al. Basal and TRH stimulated Thyroid and Pituitary hormones in various degree of renal insufficiency. Acta Endocrinol, 1979; 90 23-32.
- Feinstein EI, Kaptein EM, Nicoloff JT & Massry SG. Thyroid function in patients with nephrotic syndrome and normal renal American Journal of Nephrology 1982 2 70–76.
- Chadha V & Alon US. Bilateral nephrectomy reverses hypothyroidism in congenital nephrotic syndrome. Pediatric Nephrology 1999 13 209– 211
- Capasso G, Kinne R, De Santo NG & Giordano The use of micropuncture, isolated tubule, and vesicle technique in the study of the action of thyroid hormones on the proximal tubule function. Uremia Investigation 1985 9 151–157.
- Thyroid dysfunction in chronic renal failure. A study of the pituitary- thyroid axis and peripheral turnover kinetics of thyroxine and Lim VS, Fang
- VS, Katz AI, Refetoff Kidney International (2005) 67, 1047–1052; doi:10.1111/j.1523- 1755.2005.00169.x
- Adler SM & Wartofsky The nonthyroidal illness syndrome . Endocrinology and Metabolism Clinics of North America 2007 36 657672.
- Lo JC, Chertow GM, Go AS & Hsu Increased prevalence of subclinical and clinical hypothyroidism in persons with chronic kidney disease. Kidney International 2005 67 1047–1052.
- Sanai T, Inoue T, Okamura K, Sato K, Yamamoto K, Abe T, Node K, Tsuruya K & Iida M. Reversible primary hypothyroidism in Japanese patients undergoing maintenance hemodialysis. Clinical Nephrology 2008 69 107–113
- Rodrigues MC, Santos GM, da Silva CA, Baxter JD, Webb P, Lomri N, Neves FA, Ribeiro RC & Simeoni LA. Thyroid hormone transport is disturbed in erythrocytes from patients with chronic renal failure on hemodialysis. Renal Failure 2004 26 461–466
- Kang EW, Nam JY, Yoo TH, Shin SK, Kang SW & Han SH. Clinical implications of subclinical hypothyroidism in continuous ambulatory peritoneal dialysis patients. American Journal of Nephrology 2008: 28 ;908–913.
- Acker CG, Flick R, Shapiro R, Scantlebury VP, Jordan ML, Vivas C, Greenberg A & Johnson JP. Thyroid hormone in the treatment of post- transplant acute tubular necrosis (ATN). American Journal of Transplantation 2002 2 57–61.
- Shaheen FA, Al-Khader AA: Preventive strategies of renal failure in the Arab world. Kidney Int SupplS37 –S40,2005
- Cerda J, Cerda M, Kilcullen P, Prendergast J: In severe acute kidney injury, a higher serum creatinine is paradoxically associated with better patient survival. Nephrol Dial Transplant22 :2781 –2784,2007
- Liangos O, Wald R, O’Bell JW, Price L, Pereira BJ, Jaber BL: Epidemiology and outcomes of acute renal failure in hospitalized patients: A national survey. Clin J Am Soc Nephrol1 :43 –51,2006