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.
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