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Unlu H, Yehia A, Manji K, Manji N, Treviño-Alvarez AM, Cabeza De Baca T, Frye MA, Thomas LF, Abulseoud OA. Bidirectional negative relationship between thyrotropin and kidney function during alcohol intoxication in males. FRONTIERS IN NEPHROLOGY 2024; 4:1322791. [PMID: 39175745 PMCID: PMC11339534 DOI: 10.3389/fneph.2024.1322791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 05/21/2024] [Indexed: 08/24/2024]
Abstract
Introduction Despite a well-established direct toxic effect of alcohol on renal cells, there is a salutary dose-dependent effect of alcohol consumption on common laboratory parameters related to kidney performance. Alcohol also impacts thyroid hormones, while thyroid status modulates kidney function. The modulation of kidney parameters with thyrotropin (TSH) and thyroid status indicates a possible interaction between alcohol, kidney, and thyroid functions. This retrospective study was conducted to test the hypothesis that the positive effect of alcohol use on the estimated glomerular filtration rate (eGFR) is mediated by alcohol's effect on thyroid hormones. Methods We reviewed the electronic medical records of 767 hospitalized adult patients free of thyroid disorders who received medical care in the Mayo Clinic Health System from June 2019 through June 2022 and had blood alcohol concentration (BAC), serum TSH, and serum creatinine measured during the hospitalization. We calculated the eGFR using both the re-expressed Modification of Diet in Renal Disease (MDRD II) study equation and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) Creatinine equation. Results We found a significant relationship of BAC with eGFR (CKD-EPI) and TSH in males only. BAC had a positive association with eGFR (b = 0.24, p = 0.0001) and negative with TSH (b=-0.17, p = 0.006). The covariance between the two outcomes (eGFR and TSH) was negative (b = -0.12, p = 0.049). The path analyses using the eGFR MDRD II equation were not significant in males, whereas females had no significant path analyses with either of the eGFR equations. Discussion We observed that BAC influences both eGFR and TSH, whereas eGFR and TSH influence each other. After considering important covariates (e.g., age, body mass index, diabetes mellitus, cardiovascular disease, chronic kidney disease, and chronic liver disease) and the negative bidirectional effect of TSH and eGFR, a positive impact of BAC on eGFR was observed in males.
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Affiliation(s)
- Hayrunnisa Unlu
- Department of Psychiatry and Psychology, Mayo Clinic Arizona, Phoenix, AZ, United States
| | - Asmaa Yehia
- Department of Neuroscience, Graduate School of Biomedical Sciences, Mayo Clinic College of Medicine, Phoenix, AZ, United States
- Department of Medical Physiology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Khalid Manji
- Department of Psychiatry and Psychology, Mayo Clinic Arizona, Phoenix, AZ, United States
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Faculty of Medicine and Dentistry, Queen Mary University of London, Victoria, Malta
| | - Noah Manji
- Department of Psychiatry and Psychology, Mayo Clinic Arizona, Phoenix, AZ, United States
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Faculty of Medicine and Dentistry, Queen Mary University of London, Victoria, Malta
| | - Andrés M. Treviño-Alvarez
- Obesity & Diabetes Clinical Research Section, Phoenix Epidemiology & Clinical Research Branch, National Institute of Health/National Institute on Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, United States
- Department of Psychiatry, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Tommy Cabeza De Baca
- Obesity & Diabetes Clinical Research Section, Phoenix Epidemiology & Clinical Research Branch, National Institute of Health/National Institute on Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, United States
| | - Mark A. Frye
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, United States
| | - Leslie F. Thomas
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic in Arizona, Scottsdale, AZ, United States
| | - Osama A. Abulseoud
- Department of Psychiatry and Psychology, Mayo Clinic Arizona, Phoenix, AZ, United States
- Department of Neuroscience, Graduate School of Biomedical Sciences, Mayo Clinic College of Medicine, Phoenix, AZ, United States
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Peterson ME, Rishniw M. Urine concentrating ability in cats with hyperthyroidism: Influence of radioiodine treatment, masked azotemia, and iatrogenic hypothyroidism. J Vet Intern Med 2023; 37:2039-2051. [PMID: 37668163 PMCID: PMC10658547 DOI: 10.1111/jvim.16849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 08/23/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Hyperthyroid cats often have urine specific gravity (USG) values <1.035. It remains unclear how USG changes after treatment, if USG can be used to predict azotemia after treatment, or how iatrogenic hypothyroidism influences USG values. OBJECTIVES To determine the proportion of hyperthyroid cats with USG <1.035 vs ≥1.035; if USG changes after treatment; and whether USG <1.035 correlated with unmasking of azotemia or hypothyroidism. ANIMALS Six hundred fifty-five hyperthyroid cats treated with radioiodine; 190 clinically normal cats. METHODS Prospective, before-and-after study. Hyperthyroid cats had serum thyroxine, thyroid-stimulating hormone, and creatinine concentrations, and USG measured before and 6 months after successful treatment with radioiodine. RESULTS Of untreated hyperthyroid cats, USG was ≥1.035 in 346 (52.8%) and <1.035 in 309 (47.2%). After treatment, 279/346 (80.6%) maintained USG ≥1.035, whereas 67/346 (19.4%) became <1.035; 272/309 (88%) maintained USG <1.035, whereas 37/309 (12%) became ≥1.035. Only 22/346 (6.4%) with USG ≥1.035 developed azotemia after treatment, compared with 136/309 (44%) with <1.035 (P < .001). Of cats remaining nonazotemic, 38% had USG <1.035, compared with 20% of normal cats (P < .001). The 137 cats with iatrogenic hypothyroidism had lower USG after treatment than did 508 euthyroid cats (1.024 vs 1.035), but USGs did not change after levothyroxine supplementation. USG <1.035 had high sensitivity (86.1%) but moderate specificity (65.2%) in predicting azotemia after treatment. CONCLUSIONS AND CLINICAL IMPORTANCE Hyperthyroidism appears not to affect USG in cats. However, cats with evidence of sub-optimal concentrating ability before radioiodine treatment (USG < 1.035) are more likely to develop azotemia and unmask previously occult chronic kidney disease. Iatrogenic hypothyroidism itself did not appear to affect USG values.
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Affiliation(s)
- Mark E. Peterson
- Animal Endocrine Clinic, 21 West 100th StreetNew YorkNew YorkUSA
- College of Veterinary MedicineCornell UniversityIthacaNew YorkUSA
| | - Mark Rishniw
- College of Veterinary MedicineCornell UniversityIthacaNew YorkUSA
- Veterinary Information NetworkDavisCaliforniaUSA
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Pravikova PD, Ivanova LN. Effect of Vasopressin V1a Receptor Blockade on Renal Osmoregulatory Function in L-Thyroxine-Induced Hyperthyroid Rats with Different Blood Vasopressin Levels. J EVOL BIOCHEM PHYS+ 2022. [DOI: 10.1134/s0022093022040238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Pravikova PD, Ivanova LN. Effect of NO Synthesis Blockade on Renal Osmoregulatory Function in Methimazole-Induced Hypothyroid Rats with Different Vasopressin Blood Level. J EVOL BIOCHEM PHYS+ 2021. [DOI: 10.1134/s0022093021060223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Owji MS, Varedi M, Naghibalhossaini F, Pajouhi N. Thyroid Function Modulates Lung Fluid and Alveolar Viscoelasticity in Mechanically Ventilated Rat. J Surg Res 2020; 253:272-279. [PMID: 32402852 DOI: 10.1016/j.jss.2020.03.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 02/23/2020] [Accepted: 03/30/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Mechanical ventilation (MV) is life saving; yet it may induce severe lung injury and lead to multisystem organ failure and death. Thyroid hormones (THs) promote alveolar fluid clearance and alleviates hypoxia-induced lung injury. Given that the mechanism involved in hypoxia-induced lung injury is different from that of ventilator-induced lung injury, we examined the effects of thyroid function on lung extravascular fluid (LF), aquaporin 5 (AQP 5) expression, and alveolar viscoelasticity (AVE) in mechanically ventilated rat. METHODS Hypothyroid (hypo) and hyperthyroid (hyper) animals were generated by administration of metimazole and L-thyroxine, respectively. Lung injury was induced by high-tidal volume MV. The LF was estimated by lung wet weight-to-dry weight ratio assessment. Expression of AQP 5 was evaluated by western blotting and in situ immunohistochemistry. The AVE was judged by elastic lung pressure/volume curve recording. RESULTS Injurious MV significantly reduced lung AQP 5 expression and altered LF and AVE in a thyroid function-dependent manner. Regardless of animals' ventilation mode, hyper state caused significant reductions in LF and lung AQP 5 protein. It also improved AVE irrespective of animals' ventilation mode. The effects of hypo condition on LF, AQP 5 expression, and AVE were in contrast to that of hyper state. CONCLUSIONS These data indicate that thyroid function has profound effects on LF, AQP 5, and AVE in mechanically ventilated lungs. Given that the effects of thyroidal status were as prominent as that of injurious MV, we suggest that thyroid function should be considered when patients are to be subjected to MV.
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Affiliation(s)
- Mohammad S Owji
- Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoumeh Varedi
- Department of Physiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | | | - Nasser Pajouhi
- Department of Physiology, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Lorestan, Iran
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Sönmez E, Bulur O, Ertugrul DT, Sahin K, Beyan E, Dal K. Hyperthyroidism influences renal function. Endocrine 2019; 65:144-148. [PMID: 30904999 DOI: 10.1007/s12020-019-01903-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 03/12/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE While the effects of hypothyroidism on renal function have been studied extensively, there is less information concerning the effect of hyperthyroidism. We aimed to elucidate the effect of overt and subclinical hyperthyroidism, on estimated glomerular filtration rate (eGFR) with large number of patients treated for hyperthyroidism and after euthyroidism was achieved. METHOD A total of 433 consecutive overt and subclinical hyperthyroid patients were included in the study. We assessed serum fT3, fT4, TSH, BUN, creatinine, and eGFR measurements during both hyperthyroid and euthyroid states of the same patients. The eGFR was calculated using the simplified modification of diet in renal disease (MDRD) Formula. RESULTS Among these patients, 367 had overt, and 66 had subclinical hyperthyroidism. fT3, fT4, and eGFR measurements decreased, meanwhile BUN, creatinine and TSH levels increased significantly after euthyroidism was achieved (p < 0.0001 for all). The correlation analyses revealed that eGFR in hyperthyroid state (eGFRh) and fT3 in hyperthyroid state (fT3h) (r = 0,210, p < 0,0001), and fT4 in hyperthyroid state (fT4h) (r = 0,176, p < 0,0001) were significantly correlated. ∆GFR did not differ between overt hyperthyroid group and subclinical hyperthyroid group. CONCLUSIONS We observed a significant decline in eGFR measurements after the patients became euthyroid. Some of these patients had lower values than 60 mL/min/1.73 m2, which mean that hyperthyroidism may be masking mild renal failure.
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Affiliation(s)
- Ezgi Sönmez
- Department of Internal Medicine, Health Sciences University, Kecioren Teaching and Research Hospital, Keçiören/Ankara, Turkey
| | - Oktay Bulur
- Department of Internal Medicine, Health Sciences University, Kecioren Teaching and Research Hospital, Keçiören/Ankara, Turkey.
| | - Derun Taner Ertugrul
- Department of Endocrinology and Metabolism, Health Sciences University, Kecioren Teaching and Research Hospital, Keçiören/Ankara, Turkey
| | - Kubilay Sahin
- Department of Rheumatology, Health Sciences University, Kecioren Teaching and Research Hospital, Keçiören/Ankara, Turkey
| | - Esin Beyan
- Department of Internal Medicine, Health Sciences University, Kecioren Teaching and Research Hospital, Keçiören/Ankara, Turkey
| | - Kursat Dal
- Department of Internal Medicine, Health Sciences University, Kecioren Teaching and Research Hospital, Keçiören/Ankara, Turkey
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Han Q, Zhang J, Wang Y, Li H, Zhang R, Guo R, Li L, Teng G, Wang J, Wang T, Liu F. Thyroid hormones and diabetic nephropathy: An essential relationship to recognize. Nephrology (Carlton) 2019; 24:160-169. [PMID: 29660205 DOI: 10.1111/nep.13388] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2018] [Indexed: 02/05/2023]
Affiliation(s)
- Qianqian Han
- Division of Nephrology; West China Hospital of Sichuan University; Chengdu China
| | - Junlin Zhang
- Division of Nephrology; West China Hospital of Sichuan University; Chengdu China
| | - Yiting Wang
- Division of Nephrology; West China Hospital of Sichuan University; Chengdu China
| | - Hanyu Li
- Division of Nephrology; West China Hospital of Sichuan University; Chengdu China
| | - Rui Zhang
- Division of Nephrology; West China Hospital of Sichuan University; Chengdu China
| | - Ruikun Guo
- Division of Nephrology; West China Hospital of Sichuan University; Chengdu China
| | - Li Li
- Division of Nephrology; West China Hospital of Sichuan University; Chengdu China
| | - Geer Teng
- The Faculty of Social Development and Western China Development Studies; Sichuan University; Chengdu China
| | - Jiali Wang
- Division of Nephrology; West China Hospital of Sichuan University; Chengdu China
| | - Tingli Wang
- Division of Nephrology; West China Hospital of Sichuan University; Chengdu China
| | - Fang Liu
- Division of Nephrology; West China Hospital of Sichuan University; Chengdu China
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Massolt ET, Salih M, Beukhof CM, Kam BL, Burger J, Visser WE, Hoorn EJ, Peeters RP. Effects of Thyroid Hormone on Urinary Concentrating Ability. Eur Thyroid J 2017; 6:238-242. [PMID: 29071235 PMCID: PMC5649223 DOI: 10.1159/000478521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/09/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hypothyroidism has been associated with impaired urinary concentrating ability. However, previous reports on thyroid hormone and urinary concentrating ability in humans only studied a limited number of patients with autoimmune thyroid disease or used healthy controls instead of paired analysis within the same patients. OBJECTIVE To study the urinary concentrating ability in athyreotic patients with differentiated thyroid cancer on and off levothyroxine treatment as they are exposed to different thyroid states as part of their treatment in the absence of an autoimmune disease. DESIGN AND METHODS We studied 9 patients (mean age of 42.7 years) during severe hypothyroid state (withdrawal of levothyroxine before radioactive iodine therapy) and TSH-suppressed state (on levothyroxine therapy). At these two points, serum and urine samples were collected after 14 h of overnight fasting without any food or drink. RESULTS Serum and urine osmolality were not significantly different between on and off levothyroxine treatment. Serum creatinine levels were significantly higher in patients off versus on levothyroxine treatment (87.0 vs. 71.0 µmol/L, respectively; p = 0.044) and, correspondingly, the estimated glomerular filtration rate was significantly lower (89.6 vs. 93.1 mL/min, respectively; p = 0.038). CONCLUSION Short-term, severe hypothyroidism has no effect on urinary concentrating ability. Our study confirms the well-known effects of thyroid hormone on serum creatinine concentrations.
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Affiliation(s)
- Elske T. Massolt
- Division of Endocrinology, Erasmus MC, Rotterdam, The Netherlands
- Rotterdam Thyroid Center, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
- *Elske T. Massolt, Rotterdam Thyroid Center, Department of Internal Medicine, Erasmus MC, Mailbox 2040, room Ee 500, NL–3000 CA Rotterdam (The Netherlands), E-Mail
| | - Mahdi Salih
- Department of Nephrology and Transplantation, Erasmus MC, Rotterdam, The Netherlands
| | - Carolien M. Beukhof
- Division of Endocrinology, Erasmus MC, Rotterdam, The Netherlands
- Rotterdam Thyroid Center, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Boen L.R. Kam
- Department of Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - J.W. Burger
- Division of Surgical Oncology, Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - W. Edward Visser
- Division of Endocrinology, Erasmus MC, Rotterdam, The Netherlands
- Rotterdam Thyroid Center, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Ewout J. Hoorn
- Department of Nephrology and Transplantation, Erasmus MC, Rotterdam, The Netherlands
| | - Robin P. Peeters
- Division of Endocrinology, Erasmus MC, Rotterdam, The Netherlands
- Rotterdam Thyroid Center, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
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Abstract
Thyroid hormones influence renal development, kidney hemodynamics, glomerular filtration rate and sodium and water homeostasis. Hypothyroidism and hyperthyroidism affect renal function by direct renal effects as well as systemic hemodynamic, metabolic and cardiovascular effects. Hypothyroidism has been associated with increased serum creatinine and decreased glomerular filtration rate. The reverse effects have been reported in thyrotoxicosis. Most of renal manifestations of thyroid dysfunction are reversible with treatment. Kidney disease may also cause thyroid dysfunction by several mechanisms. Nephrotic syndrome has been associated to changes in serum thyroid hormone concentrations. Different forms of glomerulonephritis and tubulointerstitial disease may be linked to thyroid derangements. A high prevalence of thyroid hormone alteration has been reported in acute kidney injury. Thyroid dysfunction is highly prevalent in chronic kidney disease patients. Subclinical hypothyroidism and low triiodothyronine syndrome are common features in patients with chronic kidney disease. Patients treated by both hemodialysis and peritoneal dialysis, and renal transplantation recipients, exhibit thyroid hormone alterations and thyroid disease with higher frequency than that found in the general population. Drugs used in the therapy of thyroid disease may lead to renal complications and, similarly, drugs used in kidney disorders may be associated to thyroid alterations. Lastly, low thyroid hormones, especially low triiodothyronine levels, in patients with chronic kidney disease have been related to a higher risk of cardiovascular disease and all-cause mortality. Interpretation of the interactions between thyroid and renal function is a challenge for clinicians involved in the treatment of patients with thyroid and kidney disease.
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Affiliation(s)
- Pedro Iglesias
- Department of Endocrinology, Hospital Ramón y Cajal, Ctra. De Colmenar, Km 9,100, 28034, Madrid, Spain.
| | - María Auxiliadora Bajo
- Department of Nephrology, Hospital La Paz, Madrid, Spain
- Department of Health Sciences, Universidad Autónoma de Madrid, Madrid, Spain
| | - Rafael Selgas
- Department of Nephrology, Hospital La Paz, Madrid, Spain
- Department of Health Sciences, Universidad Autónoma de Madrid, Madrid, Spain
| | - Juan José Díez
- Department of Endocrinology, Hospital Ramón y Cajal, Ctra. De Colmenar, Km 9,100, 28034, Madrid, Spain
- Department of Medicine, University de Alcalá de Henares, Madrid, Spain
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Abebe N, Kebede T, Wolde M. Assessment of renal function and electrolytes in patients with thyroid dysfunction in Addis Ababa, Ethiopia: a cross sectional study. Pan Afr Med J 2016; 24:338. [PMID: 28154693 PMCID: PMC5267927 DOI: 10.11604/pamj.2016.24.338.8455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 02/20/2016] [Indexed: 11/23/2022] Open
Abstract
Introduction Studies demonstrated that abnormal thyroid functions may result in decreased or increased kidney size, kidney weight, and affect renal functions. In this regard, studies on the association of abnormal thyroid functions and renal function tests are scarcely found in Ethiopia. Objective To assess renal function and electrolytes in patients with thyroid dysfunction, in Addis Ababa, Ethiopia. Methods Cross sectional study was conducted from March 21/2015-May 27/2015 at Arsho Advanced Medical Laboratory. During the study period, 71 patients with thyroid dysfunction were eligible, and socio demographic data collected by structured questionnaire. Then blood sample was collected for thyroid function tests, renal function and blood electrolyte analysis. The collected data was analyzed by SPSS version 20. ANOVA and binary logistic regression were employed to evaluate the mean deference and associations of thyroid hormone with renal function and electrolyte balances. Results Among the renal function tests, serum uric acid, and creatinine mean values were significantly decreased in hyperthyroid patients; whereas, eGFR mean value was significantly increased in hyperthyroid study patients (P<0.05). Meanwhile, from the electrolyte measurements made, only the mean serum sodium value was significantly increased in hyperthyroid study participants. Binary logistic regression analysis on the association of thyroid dysfunction with electrolyte balance and renal function tests indicated that serum sodium, creatinine, eGFR values and hyperthyroidism have a statistical significant association at AOR 95% CI of 0.141(0.033-0.593, P=0.008); 16.236(3.481-75.739, P=0.001), and 13.797(3.261-58.67, P=0.001) respectively. Conclusion The current study reveals, thyroid abnormalities may lead to renal function alterations and also may disturb electrolyte balance. Knowledge of this significant association has worthwhile value for clinicians, to manage their patients' optimally.
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Affiliation(s)
- Nardos Abebe
- Bethzatha Advanced Medical Laboratory and Registered Assessor of ISO 15189, Addis Abeba, Ethiopia
| | - Tedla Kebede
- Department of Internal medicine, College of Health Science, Addis Abeba University, Ethiopia
| | - Mistire Wolde
- Department of Medical Laboratory Sciences, College of Health Science, Addis Abeba University, Ethiopia
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Khan I, Bhat RA, Khan I, Hameed I. Grave's disease associated with immunoglobulin A nephropathy: A rare association. Indian J Nephrol 2015. [PMID: 26199479 PMCID: PMC4495482 DOI: 10.4103/0971-4065.147373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Immunoglobulin A (Ig A) nephropathy is the most common form of primary glomerulonephritis. The association of Ig A nephropathy with Grave's disease has not been reported so far. We report a case of 20-year-old female with Grave's disease who presented with edema, facial puffiness, and decreased urine output. She was found to be hypertensive with renal failure and nephrotic range proteinuria. Renal biopsy revealed features of Ig A nephropathy. The patient was treated with oral corticosteroids (1 mg/kg/day). To our knowledge, this is the first case showing association of Grave's disease with Ig A nephropathy.
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Affiliation(s)
- I Khan
- Department of Internal Medicine, Sher-i-Kashmir Institute of Medical Sciences, Jammu, Jammu and Kashmir, India
| | - R A Bhat
- Department of Internal Medicine, Sher-i-Kashmir Institute of Medical Sciences, Jammu, Jammu and Kashmir, India
| | - I Khan
- Department of Pathology, Government Medical College, Jammu, Jammu and Kashmir, India
| | - I Hameed
- Department of Immunology, Sher-i-Kashmir Institute of Medical Sciences, Jammu, Jammu and Kashmir, India
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Ramoutar V, Landa C, James LR. Acute tubular necrosis (ATN) presenting with an unusually prolonged period of marked polyuria heralded by an abrupt oliguric phase. CASE REPORTS 2014; 2014:bcr-2013-201030. [DOI: 10.1136/bcr-2013-201030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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The thyroid and the kidney: a complex interplay in health and disease. Int J Artif Organs 2014; 37:1-12. [PMID: 24634329 DOI: 10.5301/ijao.5000300] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2013] [Indexed: 11/20/2022]
Abstract
Thyroid hormones may directly affect the kidney and altered kidney function may also contribute to thyroid disorders. The renal manifestations of thyroid disorders are based on hemodynamic alterations or/and to direct effects of thyroid hormones. The renin-angiotensin system plays a crucial role in the cross-talk between the thyroid and the kidney. Hypothyroidism may be accompanied by an increase of serum creatinine and reduction of glomerular filtration rate (GFR), whereas hyperthyroidism may increase GFR. Treatment of thyroid disorders may lead to normalization of GFR. Primary and subclinical hypothyroidism and low triiodothyronine (T3) syndrome are common features in patients with chronic kidney disease (CKD). In addition low levels of thyroid hormones may predict a higher risk of cardiovascular and overall mortality in patients with end-stage renal disease. The causal nature of this correlation remains uncertain. In this review, special emphasis is given to the thyroid pathophysiology, its impact on kidney function and CKD and the interpretation of laboratorial findings of thyroid dysfunction in CKD.
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Abstract
Aquaporins (AQPs) are a family of membrane water channels that basically function as regulators of intracellular and intercellular water flow. To date, thirteen aquaporins have been characterized. They are distributed wildly in specific cell types in multiple organs and tissues. Each AQP channel consists of six membrane-spanning alpha-helices that have a central water-transporting pore. Four AQP monomers assemble to form tetramers, which are the functional units in the membrane. Some of AQPs also transport urea, glycerol, ammonia, hydrogen peroxide, and gas molecules. AQP-mediated osmotic water transport across epithelial plasma membranes facilitates transcellular fluid transport and thus water reabsorption. AQP-mediated urea and glycerol transport is involved in energy metabolism and epidermal hydration. AQP-mediated CO2 and NH3 transport across membrane maintains intracellular acid-base homeostasis. AQPs are also involved in the pathophysiology of a wide range of human diseases (including water disbalance in kidney and brain, neuroinflammatory disease, obesity, and cancer). Further work is required to determine whether aquaporins are viable therapeutic targets or reliable diagnostic and prognostic biomarkers.
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Duranton F, Lacoste A, Faurous P, Deshayes E, Ribstein J, Avignon A, Mourad G, Argilés À. Exogenous thyrotropin improves renal function in euthyroid patients, while serum creatinine levels are increased in hypothyroidism. Clin Kidney J 2013; 6:478-83. [PMID: 26064512 PMCID: PMC4438406 DOI: 10.1093/ckj/sft092] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 07/09/2013] [Indexed: 11/22/2022] Open
Abstract
Background There is evidence showing that the hypothyroid state results in increased serum creatinine levels. However, whether this is only due to the peripheral thyroid hormones or if thyroid-stimulating hormone (TSH) is also involved is not known. Methods Serum creatinine levels and estimated glomerular filtration rate (eGFR) were assessed in thyroidectomized patients with varying thyroid hormones and TSH levels. Blood samples from Group 1 (21 patients) were obtained 1 month after complete thyroidectomy, while under a hypothyroid state (t1) and a sufficient time after thyroid hormones initiation (euthyroid state, t2). Group 2 (20 euthyroid patients) were sampled after recombinant human thyrotropin injections (rhTSH, t1) and later after rhTSH extinction (t2). Results In Group 1, serum creatinine levels decreased after correction of hypothyroidism (85.3 ± 4.3 versus 78.0 ± 3.9 µmol/L; P = 0.04). In Group 2, serum creatinine levels increased after rhTSH withdrawal (70.6 ± 5.7 µmol/L versus 76.5 ± 5.8 µmol/L; P = 0.007). Between t1 and t2, eGFR varied accordingly [Group 1, 71.7 ± 3.5 versus 81.2 ± 4.5 mL/min/1.73 m² (P = 0.02); Group 2, 97.7 ± 7.4 versus 87.5 ± 5.9 (P = 0.007)]. The changes in TSH and eGFR following supplementation with thyroxine were significantly correlated (r = −0.6, P = 0.0041). Conclusions Iatrogenic hypothyroidism significantly increases serum creatinine and reversibly impairs eGFR, while treatment with rhTSH enhances renal function in euthyroid patients, supporting the existence of an influence of TSH level on renal function. The mechanisms by which peripheral thyroid hormones and TSH influence GFR need to be identified in physiology-orientated studies.
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Affiliation(s)
| | - Anouchka Lacoste
- Service de Néphrologie, Dialyse et Transplantation, Hôpital Lapeyronie, Université de Montpellier, Montpellier , France
| | | | | | - Jean Ribstein
- Service de Médecine Interne , Hôpital Lapeyronie, Université de Montpellier, Montpellier , France
| | - Antoine Avignon
- Service de Nutrition-Diabète, Hôpital Lapeyronie, Université de Montpellier, Montpellier , France
| | - Georges Mourad
- Service de Néphrologie, Dialyse et Transplantation, Hôpital Lapeyronie, Université de Montpellier, Montpellier , France
| | - Àngel Argilés
- SAS RD - Néphrologie, Montpellier , France ; Service de Néphrologie, Dialyse et Transplantation, Hôpital Lapeyronie, Université de Montpellier, Montpellier , France ; Néphrologie Dialyse St Guilhem, Sète , France
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Rein et dysthyroïdies. Nephrol Ther 2013; 9:13-20. [DOI: 10.1016/j.nephro.2012.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 06/21/2012] [Accepted: 06/24/2012] [Indexed: 11/21/2022]
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Affiliation(s)
- Jayaraman Muthukrishnan
- Department of Medicine and Endocrinology, Command Hospital, Chandimandir, Panchkula, Haryana, India
| | - Dawra Saurabh
- Department of Medicine, Command Hospital, Chandimandir, Panchkula, Haryana, India
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19
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Ho CH, Chang TC, Guo YJ, Chen SC, Yu HJ, Huang KH. Lower urinary tract symptoms and urinary flow rates in female patients with hyperthyroidism. Urology 2011; 77:50-4. [PMID: 21195824 DOI: 10.1016/j.urology.2010.07.479] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Revised: 07/14/2010] [Accepted: 07/19/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate lower urinary tract symptoms (LUTS) and voiding function in a cohort of hyperthyroid women. The autonomic nervous system (ANS) imbalance has been thought to cause LUTS in hyperthyroidism. METHODS Between January 2008 and December 2008, 65 newly diagnosed, untreated female hyperthyroid patients were enrolled in this study. Another 62 age-matched healthy women were enrolled as a control group. Demographics, LUTS, urinary flow rates, hyperthyroid symptoms, and serum levels of thyroid hormones were recorded before and after the medical treatment for hyperthyroidism. RESULTS Compared with the control group, the hyperthyroid patients had a higher mean symptom score of frequency (1.15 ± 1.75 vs 0.31 ± 1.05, P = .01), incomplete emptying (0.91 ± 1.47 vs 0.29 ± 1.12, P = .02), straining (1.05 ± 0.85 vs 0.27 ± 0.51, P <.01), voiding symptoms (3.05 ± 3.28 vs 1.06 ± 2.63, P <.01), and total symptoms (5.88 ± 6.17 vs 2.76 ± 4.65, P <.01). Fifty-three (81.5%) of them had an IPSS of <8, while only 12 (18.5%) had an International Prostate Symptom Score (IPSS) of ≥8. Hyperthyroid women demonstrated a lower mean peak flow rate (25.0 ± 5.3 vs 28.6 ± 6.1 mL/s, P = .02). After treatment, both LUTS and flow rates improved significantly. The severity of LUTS was associated with neither serum levels of thyroid hormone nor other hyperthyroid symptoms. CONCLUSIONS Hyperthyroid women have worse LUTS and lower peak flow rates than healthy controls. However, the severity of LUTS is only mild (IPSS <8) in the majority, and only 18.5% have moderate-to-severe LUTS. Both LUTS and flow rates improve after the treatment for hyperthyroidism. The exact mechanisms of LUTS and/or lower urinary tract dysfunction in hyperthyroidism require further investigation.
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Affiliation(s)
- Chen-Hsun Ho
- Division of Urology, Department of Surgery, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
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Pedersen EB, Thomsen IM, Lauridsen TG. Abnormal function of the vasopressin-cyclic-AMP-aquaporin2 axis during urine concentrating and diluting in patients with reduced renal function. A case control study. BMC Nephrol 2010; 11:26. [PMID: 20923561 PMCID: PMC2965705 DOI: 10.1186/1471-2369-11-26] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 10/05/2010] [Indexed: 12/22/2022] Open
Abstract
Background The kidneys ability to concentrate and dilute urine is deteriorated during progressive renal insufficiency. We wanted to test the hypothesis that these phenomena could be attributed to an abnormal function of the principal cells in the distal part of the nephron. Methods Healthy control subjects and patients with chronic kidney diseases were studied. Group 1 comprised healthy subjects, n = 10. Groups 2-4 comprised patients with chronic kidney disease (Group 2, n = 14, e-GFR ? 90 m1/min; Group 3, n = 11, 60 m1/min ? e-GFR < 90 ml/min; and Group 4, n = 16, 15 ml/min ? e-GFR < 60 ml/min). The subjects collected urine during 24 hours. A urine concentrating test was done by thirsting during the following 12 hours. Thereafter, a urine diluting test was performed with a water load of 20 ml/kg body weight. The effect variables were urinary excretions of aquaporin2 (u-AQP2), cyclic-AMP (u-c-AMP), urine volume (UV), free water clearance (CH2O), urine osmolarity (u-Osm), and plasma arginine vasopressin (p-AVP). Results After fluid deprivation, u-Osm increased. In all groups, UV and CH2O decreased and u-AQP2 and u-c-AMP increased in Groups 1 and 2, but were unchanged in Group 3 and 4. P-AVP was significantly higher in Group 4 than in the other groups. During urine diluting, UV and CH2O reached significantly higher levels in Groups 1-3 than Group 4. Both before and after water loading, u-AQP2 and p-AVP were significantly higher and u-c-AMP was significantly lower in Group 4 than the other groups. Estimated-GFR was correlated negatively to p-AVP and positively to u-c-AMP. Conclusions Patients with moderately severe chronic kidney disease have a reduced renal concentrating and diluting capacity compared to both patients with milder chronic kidney disease and healthy control subjects. These phenomena can be attributed, at least partly, to an abnormally decreased response in the AVP-c-AMP-AQP2 axis. ClinicalTrials.Gov Identifier: NCT00313430
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Affiliation(s)
- Erling B Pedersen
- Department of Medical Research, Holstebro Hospital, Laegaardvej 12, 7500 Holstebro, Denmark.
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Aydin L, Mogulkoc R, Baltaci AK. Influences of hypertonic and hypovolemic treatments on vasopressin response in propylthiouracil (PTU) induced hypothyroid rat and effect on supplementation with L-thyroxine. ACTA BIOLOGICA HUNGARICA 2010; 61:1-9. [PMID: 20194094 DOI: 10.1556/abiol.61.2010.1.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This study was performed to investigate the effects of L-thyroxine treatment on plasma vasopressin (AVP) levels in rats with hypothyroidism induced by propylthiouracil (PTU). Animals were separated into three groups each having 6 rats: control, PTU, PTU+L-thyroxine groups. Then, the groups were further divided into 3 sub-groups including 6 rats (a; basal, b; hypertonic stimulated and c; hypovolemic stimulated). At the end of the experiments all rats were decapitated in order to obtain plasma samples for analysis in terms of Hct, osmolality, TT 3 , TT 4 and vasopressin. Haematocrit (Hct) levels were the highest in hypovolemic stimulated sub-group (P < 0.001). Osmolality levels were higher in hypertonic stimulated sub-groups (P < 0.001). Total T 3 and T 4 values were the lowest in the PTU group and the highest in the L-thyroxine treated group (P < 0.001). Plasma AVP levels were reduced by hypothyroidism. However, L-thyroxine treatment after the hypothyroidism prevented this reduction (P < 0.001). Vasopressin responses to basal, hypovolemic and hypertonic stimulations were the lowest in the PTU group (P < 0.001). The results of the present study show that basal and stimulated plasma vasopressin levels are reduced in PTU-induced hypothyroidism. However, L-thyroxine treatment following hypothyroidism prevents this reduction.
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Affiliation(s)
- Leyla Aydin
- Department of Physiology, Meram Medical School, Selcuk University, Konya, Turkey
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Abstract
Impaired urinary dilution leading to water retention and hyponatremia may occur in patients with cardiac failure, cirrhosis, pregnancy, oxytocin administration, hypothyroidism, glucocorticoid, and mineralocorticoid deficiency. The mechanisms for these defects predominantly involve the nonosmotic stimulation of arginine vasopressin release with up-regulation of aquaporin 2 water channel expression and trafficking to the apical membrane of the principal cells of the collecting duct. These perturbations are reversed by V2 vasopressin receptor antagonists. In contrast, urinary concentration defects leading to polyuria are vasopressin resistant. They may involve several factors, such as impaired countercurrent concentration secondary to down-regulation of Na-K-2Cl cotransporter. Vasopressin-resistant down-regulation of aquaporin 2 expression has also been described as a factor in impaired urinary concentration.
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Affiliation(s)
- Robert W Schrier
- Division of Renal Diseases and Hypertension-School of Medicine, Department of Medicine, University of Colorado at Denver Health Sciences Center, Denver, CO 80262-3706, USA.
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Li C, Wang W, Summer SN, Falk S, Schrier RW. Downregulation of UT-A1/UT-A3 is associated with urinary concentrating defect in glucocorticoid-excess state. J Am Soc Nephrol 2008; 19:1975-81. [PMID: 18667732 PMCID: PMC2551574 DOI: 10.1681/asn.2008010051] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Accepted: 05/15/2008] [Indexed: 11/03/2022] Open
Abstract
Excessive glucocorticoid hormone, as occurs with Cushing syndrome, is known to be associated with altered body water homeostasis, but the molecular mechanisms are unknown. In this study, rats treated with daily dexamethasone (Dex) for 14 d provided a model of Cushing syndrome. Compared with control rats, Dex-treated rats demonstrated increased mean arterial pressure, urine flow rate, and urinary excretion of both sodium and urea. Dex-treated rats had increased abundance of aquaporin 1 (AQP1), AQP3, and Na-K-2Cl co-transporter proteins and a marked reduction of the urea transporters UT-A1 and UT-A3. In response to an acute water load, Dex-treated rats increased water excretion more than control rats, but both groups exhibited similar AQP2 expression. In response to fluid deprivation, Dex-treated rats demonstrated an impaired urinary concentrating capacity: Urine flow rate was higher and urine osmolality was lower than control rats despite an increase in AQP1, AQP3, and Na-K-2Cl co-transporter expression. AQP2 expression was similar between the two groups, but UT-A1 and UT-A3 were decreased and urinary urea excretion was increased in Dex-treated rats. Because Dex-treated rats ingested less food and water compared with controls, paired food and water studies were performed; these substantiated the previous results. In summary, the alterations in body water observed with glucocorticoid excess may be a result, in part, of impaired urinary concentrating capacity; downregulation of UT-A1 and UT-A3 and increased urea excretion may contribute to this impairment.
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Affiliation(s)
- Chunling Li
- Department of Medicine, University of Colorado Health Sciences Center, Denver, CO 80262, USA
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