The Journal of Medical Sciences

Register      Login

VOLUME 10 , ISSUE 1--4 ( January-December, 2024 ) > List of Articles

RESEARCH ARTICLE

Assessment of Renal Function Test and Estimated Glomerular Filtration Rate in Subclinical Hypothyroidism

Vijayalakshmi Pragaspathy, Abirami Pragaspathy

Keywords : Creatinine, Estimated glomerular filtration rate, Renal dysfunction

DOI: 10.5005/jp-journals-10045-00258

License: CC BY-NC 4.0

Published Online: 10-06-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Introduction: The relationship between renal dysfunction and endocrine functions leading to a hypometabolic state is known. However, there is a lack of data regarding early treatment for subclinical hypothyroidism (SCH). When serum creatinine is elevated in SCH, it demands the need for investigation to assess if the elevated serum creatinine is due to true renal impairment and reduced glomerular filtration rate (GFR). For this, the estimated glomerular filtration rate (eGFR) helps in understanding the pathogenesis of renal involvement. Aims and objectives: The aim of the current study is to assess renal parameters, such as serum creatinine, urea, and uric acid levels in hypothyroid and SCH cases, and compare them with euthyroid patients. Materials and methods: A cross-sectional descriptive study was conducted from August 2019 to January 2020 at a tertiary care center in Bengaluru. A total of 90 hypothyroid female cases (including clinical hypothyroid and subclinical) were enrolled, along with age-matched 100 healthy controls. The Erba EM 360, a fully automated analyzer, was used to estimate serum creatinine, urea, and uric acid. Free triiodothyronine (fT3), free thyroxine (fT4), and thyroid-stimulating hormone (TSH) were analyzed using the Maglumi 800 chemiluminescent immunoassay (CLIA). The modification of diet in renal disease (MDRD) study equation and the chronic kidney disease-epidemiology collaboration (CKD-EPI) equation were utilized for the eGFR calculation. Results were presented as mean ± standard deviation (SD). The unpaired Student's t-test was applied to assess the association between cases and controls. Analysis of variance (ANOVA) was used to compare SCH and overt hypothyroid cases with controls. A p-value of <0.05 was considered statistically significant. Pearson's correlation coefficient was applied to evaluate the correlation between study groups. Result: Both MDRD eGFR and CKD-EPI were decreased in cases compared to controls, with a p-value of <0.01. There were three groups: SCH—group II (n = 50), clinical hypothyroidism (CH)—group III (n = 40), and controls—group I. Statistically significant differences were observed with eGFR calculated by MDRD and CKD-EPI between SCH, CH, and control groups (p < 0.01). TSH showed a moderate negative correlation with eGFR calculated by MDRD and CKD-EPI, with correlation coefficients of −0.43 (p < 0.01) and −0.47 (p < 0.001), respectively. Conclusion: Kidney function, compromised in thyroid dysfunction, can be early assessed with eGFR. Early diagnosis of kidney damage helps determine the at-risk population and enables timely management and prevention of associated future complications.


PDF Share
  1. Biondi B, Cooper DS. The clinical significance of subclinical thyroid dysfunction. Endocr Rev 2008;29(1):76–131. DOI: 10.1210/er.2006-0043
  2. Dhok JA, Adole SP, Puppalwar VP. Status of thyroid disorders at Acharya Vinobha Bhave Rural Hospital, Sawangi (Meghe), Wardha, India. Thyroid Res Pract 2015;12(2):62–66. DOI: 10.4103/0973-0354.153342
  3. Garber JR, Cobin RH, Gharib H, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract 2012;18(6):988–1028. DOI: 10.4158/EP12280.GL
  4. Chaker L, Razvi S, Bensenor IM, et al. Hypothyroidism. Nat Rev Dis Primers 2022;8(1):30. DOI: 10.1038/s41572-022-00357-7
  5. Shamsadini S, Darvish-Moghaddam S, Abdollahi H, et al. Creatinine, blood urea nitrogen and thyroid hormone levels before and after haemodialysis. East Mediterr Health J 2006 12(1-2):231–235. PMID: 17037243.
  6. Nitta K, Tsuchiya K. Recent advances in the pathophysiology and management of protein-energy wasting in chronic kidney disease. Ren Replace Ther 2016;2(4):1–12. DOI: 10.1186/s41100-016-0015-5
  7. Shin DH, Lee MJ, Kim SJ, et al. Preservation of renal function by thyroid hormone replacement therapy in chronic kidney disease patients with subclinical hypothyroidism. J Clin Endocrinol Metab 2012;97(8):2732–2740. DOI: 10.1210/jc.2012-1663
  8. Englund FI, Berggren K, Usener B, et al. The effect of thyroid dysfunction on plasma creatinine levels. Ann Thyroid Res 2016;2(2):82–86.
  9. Pundir H, Dan S, Manhas S. Clinical and laboratory evaluation between serum cholesterol and thyroid stimulating hormone level in the patients of thyroid dysfunction and hypothyroidism. Appl Nanobiosci 2022;11(1):3036–3048. DOI: 10.33263/LIANBS111.30363048
  10. Carrero JJ, Qureshi AR, Axelsson J, et al. Clinical and biochemical implications of low thyroid hormone levels (total and free forms) in euthyroid patients with chronic kidney disease. J Intern Med 2007;262(6):690–701. DOI: 10.1111/j.1365-2796.2007.01865.x
  11. Zhang C, Qian C, Wang W, et al. AIDS with obesity, hypothyroidism and elevated serum creatinine: a case report. Front Med (Lausanne) 2023;1–4(10):1090659. DOI: 10.3389/fmed.2023.1090659
  12. Enia G, Panuccio V, Cutrupi S, et al. Subclinical hypothyroidism is linked to micro-inflammation and predicts death in continuous ambulatory peritoneal dialysis. Nephrol Dial Transplant 2007;22(2):538–544. DOI: 10.1093/ndt/gfl605
  13. Chen HS, Wu TE, Jap TS, et al. Subclinical hypothyroidism is a risk factor for nephropathy and cardiovascular diseases in type 2 diabetic patients. Diabet Med 2007;24(12):1336–1344. DOI: 10.1111/j.1464-5491.2007.02270.x
  14. Altay M, Duranay M, Ceri M. Rhabdomyolysis due to hypothyroidism. Nephrol Dial Transplant 2005;20(4):847–848. DOI: 10.1093/ndt/gfh745
  15. den Hollander JG, Wulkan RW, Mantel MJ, et al. Correlation between severity of thyroid dysfunction and renal function. Clin Endocrinol (Oxf) 2005;62(4):423–427. DOI: 10.1111/j.1365-2265.2005.02236.x
  16. Giordano N, Santacroce C, Mattii G, et al. Hyperuricemia and gout in thyroid endocrine disorders. Clin Exp Rheumatol 2001;19(6):661–665. PMID: 11791637.
  17. Huang X, Ding L, Peng K, et al. Thyroid hormones associate with risk of incident chronic kidney disease and rapid decline in renal function: a prospective investigation. J Transl Med 2016;14(1):336. DOI: 10.1186/s12967-016-1081-8
  18. Jalalonmuhali M, Lim S, Md Shah MN, et al. MDRD vs. CKD-EPI in comparison to 51chromium EDTA: a cross sectional study of Malaysian CKD cohort. BMC Nephrol 2017;18(1):363. DOI: 10.1186/s12882-017-0776-2
  19. Chen LI, Guh JY, Wu KD, et al. Modification of diet in renal disease (MDRD) study and CKD epidemiology collaboration (CKD-EPI) equations for Taiwanese adults. 2014;9(6):1–9. DOI: 10.1371/journal.pone.0099645
  20. Mazzachi BC, Peake MJ, Ehrhardt V. Reference range and method comparison studies for enzymatic and Jaffe creatine assays in plasma and serum and early morning urine. Clin Lab 2000;46(1-2):53–55. PMID: 10745982.
  21. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney International 2012;2(1).
  22. Meuwese CL, Gussekloo J, de Craen AJ, et al. Thyroid status and renal function in older persons in the general population. J Clin Endocrinol Metab 2014;99(8):2689–2696. DOI: 10.1210/jc.2013-3778
  23. Baird MF, Graham SM, Baker JS, et al. Creatine-kinase- and exercise-related muscle damage implications for muscle performance and recovery. J Nutr Metab 2012;2012:960363. DOI: 10.1155/2012/960363
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.