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01-06-2014 | Original Article

Steroids combined with levothyroxine to treat children with idiopathic nephrotic syndrome: a retrospective single-center study

Authors: Qing-yin Guo, Qing-jun Zhu, Yu-feng Liu, Hui-juan Zhang, Ying Ding, Wen-sheng Zhai, Xian-qing Ren, Jian Zhang, Xia Zhang, Meng Yang

Published in: Pediatric Nephrology | Issue 6/2014

Abstract

Background

The clinical efficacy and safety of low-dose levothyroxine in the treatment of idiopathic nephritic syndrome accompanied by thyroid dysfunction have not been established.

Methods

One hundred and sixty-four patients were divided into three groups according to the levels of thyroid hormone and treatment. The thyroid status, efficacy and adverse reactions of thyroid treatment were observed in each group.

Results

Thyroid dysfunction was found in 73 patients. 40 cases were treated with steroids combined with levothyroxine. Proteinuria, cholesterol and thyroid-stimulating hormone (TSH) levels were significantly higher in patients with thyroid dysfunction, whereas serum albumin and free and total T3 and T4 levels were lower than those of euthyroid patients. The time for proteinuria remission in patients receiving levothyroxine therapy was shorter and their serum albumin higher than for patients without levothyroxine treatment.

Conclusions

Thyroid hormonal changes are related to the degree of both proteinuria and serum albumin in patients with INS. Combined treatment with low-dose levothyroxine supplementation and steroids in children with INS and thyroid dysfunction is associated with reduced proteinuria and increased plasma albumin compared with patients treated with steroids only.

Kaptein EM, Feinstein EI, Massry SG (1982) Thyroid hormone metabolism in renal diseases. Contrib Nephrol 33:122–135PubMed

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

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

Kaptein EM, Hoopes MT, Parise M, Massry SG (1991) rT3 metabolism in patients with nephrotic syndrome and normal GFR compared with normal subjects. Am J Physiol 260:E641–E650PubMed

Dagan A, Cleper R, Krause I, Blumenthal D, Davidovits M (2012) Hypothyroidism in children with steroid-resistant nephrotic syndrome. Nephrol Dial Transplant 27:2171–2175PubMedCrossRef

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

Ito S, Kano K, Ando T, Ichimura T (1994) Thyroid function in children with nephrotic syndrome. Pediatr Nephrol 8:412–415PubMedCrossRef

Ikeda K, Maruyama Y, Yokoyama M, Kato N, Yamanoto H, Kaguchi Y, Nakayama M, Shimada T, Tojo K, Kawamura T, Hosoya T (2001) Association of Graves’ disease with Evans’ syndrome in a patient with IgA nephropathy. Intern Med 40:1004–1010PubMedCrossRef

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 19:988–989PubMedCrossRef

10.

Nishimoto A, Tomiyoshi Y, Sakemi T, Kanegae F, Nakamura M, Ikeda Y, Shimazu K, Yonemitsu N (2000) Simultaneous occurrence of minimal change glomerular disease, sarcoidosis and Hashimoto’s thyroiditis. Am J Nephrol 20:425–428PubMedCrossRef

11.

Kagiyama S, Tsuruta H, Tominaga M, Morishita K, Doi Y, Onoyama K (1999) Minimal-change nephrotic syndrome and acute renal failure in a patient with aged onset insulin-dependent diabetes mellitus and autoimmune thyroiditis. Am J Nephrol 19:369–372PubMedCrossRef

12.

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

13.

Katz AI, Emmanouel DS, Lindheimer MD (1975) Thyroid hormone and the kidney. Nephron 15:223–249PubMedCrossRef

14.

Mariani LH, Berns JS (2012) The renal manifestations of thyroid disease. J Am Soc Nephrol 23:22–26PubMedCrossRef

15.

Capasso G, De Tommaso G, Pica A, Anastasio P, Capasso J, Kinne R, De Santo NG (1999) Effects of thyroid hormones on heart and kidney functions. Miner Electrolyte Metab 25:56–64PubMedCrossRef

16.

Gumieniak O, Perlstein TS, Hopkins PN, Brown NJ, Murphey LJ, Jeunemaitre X, Hollenberg NK, Williams GH (2004) Thyroid function and blood pressure homeostasis in euthyroid subjects. J Clin Endocrinol Metab 89:3455–3461PubMedCrossRef

17.

Chadha V, Alon US (1999) Bilateral nephrectomy reverses hypothyroidism in congenital nephrotic syndrome. Pediatr Nephrol 13:209–211PubMedCrossRef

18.

Mattoo TK (1994) Hypothyroidism in infants with nephrotic syndrome. Pediatr Nephrol 8:657–659PubMedCrossRef

19.

Gattineni J, Sas D, Dagan A, Dwarakanath V, Baum M (2008) Effect of thyroid hormone on the postnatal renal expression of NHE8. Am J Physiol Renal Physiol 294:F198–F204PubMedCrossRef

Title: Steroids combined with levothyroxine to treat children with idiopathic nephrotic syndrome: a retrospective single-center study
Authors: Qing-yin Guo
Qing-jun Zhu
Yu-feng Liu
Hui-juan Zhang
Ying Ding
Wen-sheng Zhai
Xian-qing Ren
Jian Zhang
Xia Zhang
Meng Yang
Publication date: 01-06-2014
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Nephrology / Issue 6/2014
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-013-2727-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Steroids combined with levothyroxine to treat children with idiopathic nephrotic syndrome: a retrospective single-center study

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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