Effect of Combination Treatment for Hypothyroidism on Renal Function in Patients with Hypothyroidism
Objective. To improve known methods of diagnosing kidney damage in patients suffering from hypothyroidism with elements of metabolic syndrome, to study the effect of combined treatment on renal function. Materials and methods. The study included 240 patients with primary hypothyroidism (among them — 130 patients with primary hypothyroidism with components of the metabolic syndrome). All patients were divided into 2 groups: the I group included 42 patients with hypothyroidism without obesity (age 44.8 ± 5.7 years; body mass index (BMI) 21.3 ± 2.6 kg/m2); group II — 45 patients with hypothyroidism and abdominal obesity (age 43.8 ± 6.1 years; BMI 33.4 ± 4.8 kg/m2). The control group included 20 healthy individuals (age 43.5 ± 5.9 years; BMI 22.0 ± 2.4 kg/m2). Kidney damage was detected in violation of glomerular filter permeability — occurrence of albuminuria and parameters of glomerular filtration rate (GFR) were determined using CKD-EPI formulas. The concentration of monocyte chemoattractant protein-1 (MCP-1), leptin, insulin was determined by immunoenzyme assay. Results. During the correlation analysis, between GFR in patients of group I we have established: moderate inverse correlation between the level of GFR and thyroid stimulating hormone (TSH) (r = 0.571), GFR and vascular endothelial growth factor (r = –0.616), GFR anf interleukin-6 (IL-6) (r = –0.418), total cholesterol (ChS) (r = –0.311), GFR and insulin resistance index (IIR) (r = –0.606) and weak inverse relationship between level of GFR and MCP-1 (r = –0.2917). In the II group of patients, a strong direct correlation between the level of GFR and IIR (r = 0.819), Caro index (r = 0.793) and a strong inverse correlation between GFR and TSH (r = –0.782), GFR and HOMA index (r = –0.875), moderate inverse correlation between the levels of GFR and ChS (r = –0.577), leptin (r = –0.476), GFR and IL-6 (r = –0.418), GFR and glucose (r = –0.436) and vascular endothelial growth factor (r = –0.337). Conclusions. In patients with uncompensated hypothyroidism, we have detected renal dysfunction, which was characterized by a decrease in GFR, albuminuria appearance. During combined treatment with the inclusion of angiotensin-converting enzyme inhibitor (enalapril) and atorvastatin, we have noted pathogenetically grounded effect on markers of functional kidney injury.
Zakharova SM, Savelieva LV. Obesity and hypothyroidism. Obesity and metabolism. 2013; 2:54 -58.
Dobronravov VA, Smirnov AV, Kayukov IG. Diverse albuminuria: aspects of clinical value. Nephrology. 2009; 13 (3): 33-38.
Zelinska NB. Diagnostic pathologies of the cardiovascular system in patients with hypothyroidism. Clinical Endocrinology and Endocrine Surgery. 2010; 1 (30): 58-60.
Kuzmenko Yu Yu. Morphological and functional changes in renal parenchyma of rats with prolonged experimental hypothyroidism. Ukrainian morphological almanac. 2011; 9 (1): 60-62.
Kupnovytska IG, Martyniv IV, Myhal LA. Renal effects of atorvastatin. Therapeutic Ukrainian Magazine. 2011; 3: 97-10.
Mitchenko OI, Romanov VYu, Logvinenko AO. Cardiovascular risk on the background of thyroid dysfunction. Ukrainian Cardiological Magazine. 2011; 1:21-28.
Mukhin NA, Fomin VV, Moisieiev SV. Microalbuminuria – a universal marker of poor prognosis. Clinical medicine. 2008; 11: P.4-9.
Orlova MM, Rodionova TI. Diagnostic significance of studying serum concentrations and urinary excretion of some cytokines with manifest hypothyroidism. Cytokines and Inflammation. 2012; 2 (11): 24-28.
Pertseva TO, Rokutova MK. Effect of insulin resistance on renal function in patients with abdominal obesity. Medical prospects. 2015; 20 (2): 30-36.
Fedorova EYu, Kutyrina IM. Mechanisms of kidney damage progression with obesity. Nephrology and dialysis. 2006; 8 (2): 104-111.
Andersen NH, Poulsen SH, Eiskjer H. et al. Decreased left ventricular longitudinal contraction in normotensive and normoalbuminuric patients with Type II diabetes mellitus: a Doppler tissue tracking and strain rate echocardiography study. Clinical Science. 2003; 105: 59-66.
Asvold BO, Bjoro T, Nilsen TI, Vatten LJ. Association between blood pressure and serum thyroid-stimulating hormone concentration within the reference range: a population-based study. J. Clin. Endocrinol. Metab. 2007; 92(3): 841-845.
Wang Y, Chen X, Song Y. Association between obesity and kidney disease: a systemic review and meta-analysis. Kidney Int. 2008; 73: 19-33.
Basu G, Mohapatra A. Interactions between thyroid disorders and kidney disease. Indian J. Endocrinol. Metab. 2012; 16 (2): 204-213.
Cirillo L, Santo PDe, Mancini D. et al. Definition of kidney dysfunction as a cardiovascular risk factor. Use of urinary albumin excretion and estimated glomerular filtration rate. Arch. Intern. Med. 2008; 168 (6): 617-624.
Carrero J.J, Qureshi A.R, Axelsson J. et al. Clinical and biochemical implications of low thyroid hormone levels (total and free forms) in euthyroid patients with chronic kidney disease. Journal of Internal Medicine. 2007; 262 (6): 690-701.
Hollander J.G, Wulkan R.W, Mantel M.J, Berghout A. Correlation between severity of thyroid dysfunction and renal function. Clin. Endocrinol (Oxf). 2005; 62: 423-427.
Connor А, Taylor JE. Renal impairment resulting from hypothyroidism. NDT Plus. 2008; 6: 440-441.
Stoyanov P, Navarro JA, Herrero E, Gutierrez M.J. Decrease in renal function associated with hypothyroidism. Nephrologia. 2010; 30 (3): 378-380.
Zeeuw De D, Parving HH, Henning RH. Microalbuminuria as an early marker for cardiovascular disease. J. Am. Soc. Nephrol. 2006; 17 (8): 2100-2105.
Praga M, Hernández E, Morales E. et al. Clinical features and long-term outcome of obesity-associated focal segmental glomerulosclerosis. Nephrol. Dial. Transplant. 2001; 16:1790-1798.
Sarafidis PA, Bakris GL. Microalbuminuria and chronic kidney disease as risk factor for cardiovascular disease. Nephrol. Dial. Transplant. 2006; 21(9): 2366-2374.
Shin DH, Lee MJ, Kim SJ. Preservation of renal function by thyroid hormone replacement therapy in chronic kidney disease patients with subclinical hypothyroidism.The Journal of Clinical Endocrinology and Metabolism. 2012; 20 [Epub ahead of print].
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