Concurrent Hypothyroidism with IgA Nephropathy Presenting with Acute Heart and Oliguric Renal Failure

Abstract

Hypothyroidism and renal impairment affect each other, and they both can predispose to heart failure. We encountered a 55-year-old woman with presentations of both acute heart and renal failure. She had history of subtotal thyroidectomy for hyperthyroidism, came to our hospital due to general edema, oliguria, orthopnea, and proteinuria. Chest X-ray revealed pulmonary congestion and bilateral pleural effusion. Serum exams found frank hypothyroidism with free thyroxine (T4) of 0.8 ng/dL and thyroid-stimulating hormone (TSH) of 39.382 μIU/mL. Estimated glomerular filtration rate (eGFR) was 67.2 mL/min/1.73 m2. Daily urine output was 300 mL, containing total protein of 0.8 gram. Echocardiography indicated systolic heart failure with ejection fraction of 26%. Kidney biopsy for acute oliguric renal failure, overt proteinuria, and probable glomerulopathy revealed immunoglobulin A (IgA) nephropathy. After thyroxine replenishment with co-administration of angiotensin receptor blocker, all symptoms resolved. eGFR increased almost by half to 96.7 mL/min/1.73 m2 and urine protein was undetected. We attempt to emphasize the under-diagnosis of thyroid dysfunction and glomerulonephritis beneath each other and initial presentation of acute heart and oliguric renal failure.