Abstract
Background: The interactions between thyroid and kidney have been reported mainly in the patients with proteinuria coexistent with autoimmune thyroiditis. The proposed mechanisms focus on direct effects of thyroid hormone on the hemodynamics and morphology of kidney and indirect effects through deposition of immune complexes consisting of thyroid component. Case presentation: Herein we describe two cases presenting with proteinuria associated with thyroid disorder. Both patients presented with nephrotic-range proteinuria and hematuria but were not responsive to immunosuppression therapy. Immunopathology demonstrated the deposits of multiple immunoglobulins and complements along glomerular basement membrane and mesangium. One case presented with mesangial proliferative glomerulonephritis (MsPGN) in the context of thyroid papillary carcinoma. After removal of tumor, the urine protein disappeared. This is the first report about the MsPGN related to thyroid tumor. The other case was diagnosed as MN secondary to Hashimoto’s thyroiditis. More interestingly, both patients suffered relapse of the proteinuria accompanied by opposed disturbance of thyroid hormone at the follow-up. Once the thyroid hormone was corrected, the renal function improved. Conclusion: This study proposes a possibility that a hormone-cytokine axis connecting these two organs mediates the changes of microenvironment in kidney with the thyroid hormone change, and then influence the renal function.
Highlights
The interplays between thyroid and kidney have been recognized in many disease states
The thyroid disorder and coincident nephropathy have been reported mainly in the patients presented with proteinuria and autoimmune thyroiditis (AT) [2,3,4,5,6,7]
Renal biopsy in hypothyroid patients showed thickening of the GBM and tubular basement membrane, increased meningeal matrix, as well as cytoplasmic inclusions in renal tubular epithelial cells [13]. These atypical morphology changes may account for the proteinuria and hematuria observed with hypothyroidism
Summary
The interplays between thyroid and kidney have been recognized in many disease states. The thyroid disorder and coincident nephropathy have been reported mainly in the patients presented with proteinuria and autoimmune thyroiditis (AT) [2,3,4,5,6,7]. One patient developed MsPGN secondary to thyroid cancer; the other developed the membranous nephropathy associated to Hashimoto’s thyroiditis. This is the first case of MsPGN associated to thyroid cancer Both patients developed relapse of proteinuria accompanied by opposite thyroid hormone states, namely hypothyroidism and hyperthyroidism. The thyroid function examination revealed hypothyroidismso the L-thyroxine was given at a dose of 100 ug/day immediately. Anti-thyroid stimulating hormone receptor antibodies were negative. The proteinuria disappeared accompanied by the correction of thyroid function (Figure 1B)
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