급성 신손상으로 발현된 미세 변화 신증에 동반된 자가면역갑상선염
Autoimmune thyroiditis with minimal change disease presenting acute kidney injury
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초록
Autoimmune thyroiditis is the most common cause of hypothyroidism in the world. It is characterized clinically by gradual thyroid failure, goiter formation, or both, because of the autoimmune-mediated destruction of the thyroid gland. Renal involvement presenting proteinuria in autoimmune thyroiditis is not uncommon, occurring in 10% to 30% of the cases. Glomerulonephropathy associated with autoimmune thyroiditis, however, is a rare disease. Most reports of autoimmune thyroiditis with glomerulonephropathy have demonstrated a mixed pathological morphology and have been predominantly associated with membranous glomerulopathy. The case of minimal-change disease associated with thyroiditis presenting acute kidney injury is a rare disease that has not been reported in South Korea. Reported herein is the case of a 16-year-old man diagnosed with Hashimoto’s thyroiditis, with minimal-change disease presenting acute kidney injury. He revealed hypothyroidism, proteinuria, and impaired renal function. Renal biopsy showed minimal-change disease and minimal tubular atrophy. The patient was treated with thyroid hormone, and his renal function and proteinuria improved. Therefore, for patients with autoimmune thyroiditis presenting unexplained proteinuria, glomerulonephropathy should be ruled out. Conversely, for patients with glomerulonephropathy and persistent proteinuria despite proper treatment, thyroid function and antibody tests should be performed.
Abstract
Autoimmune thyroiditis is the most common cause of hypothyroidism in the world. It is characterized clinically by gradual thyroid failure, goiter formation, or both, because of the autoimmune-mediated destruction of the thyroid gland. Renal involvement presenting proteinuria in autoimmune thyroiditis is not uncommon, occurring in 10% to 30% of the cases. Glomerulonephropathy associated with autoimmune thyroiditis, however, is a rare disease. Most reports of autoimmune thyroiditis with glomerulonephropathy have demonstrated a mixed pathological morphology and have been predominantly associated with membranous glomerulopathy. The case of minimal-change disease associated with thyroiditis presenting acute kidney injury is a rare disease that has not been reported in South Korea. Reported herein is the case of a 16-year-old man diagnosed with Hashimoto’s thyroiditis, with minimal-change disease presenting acute kidney injury. He revealed hypothyroidism, proteinuria, and impaired renal function. Renal biopsy showed minimal-change disease and minimal tubular atrophy. The patient was treated with thyroid hormone, and his renal function and proteinuria improved. Therefore, for patients with autoimmune thyroiditis presenting unexplained proteinuria, glomerulonephropathy should be ruled out. Conversely, for patients with glomerulonephropathy and persistent proteinuria despite proper treatment, thyroid function and antibody tests should be performed.
참고문헌 (15)
- Shin DH, "Thyroid hormone replacement therapy attenuates the decline of renal function in chronic kidney disease patients with subclinical hypothyroidism", Thyroid, 23, pp.654~661 (2013)
- Koçak G, "Coexistent findings of renal glomerular disease with Hashimoto’s thyroiditis", Clin Endocrinol (Oxf), 76, pp.759~762 (2012)
- Suher M, "Relation of thyroid disfunction, thyroid autoantibodies, and renal function", Ren Fail, 27, pp.739~742 (2005)
- Ronco P, "Pathophysiological lessons from rare associations of immunological disorders", Pediatr Nephrol, 24, pp.3~8 (2009)
- Valentín M, "Membranoproliferative glomerulonephritis associated with autoimmune thyroiditis", Nefrologia, 24(Suppl 3), pp.43~48 (2004)
- Iwazu Y, "A case of minimal change nephrotic syndrome with acute renal failure complicating Hashimoto’s disease", Clin Nephrol, 69, pp.47~52 (2008)
- Agras PI, "Autoimmune thyroiditis with associated proteinuria: report of two patients", J Pediatr Endocrinol Metab, 18, pp.319~322 (2005)
- Lafayette RA, "Increased serum creatinine in the absence of renal failure in profound hypothyroidism", Am J Med, 96, pp.298~299 (1994)
- Grcevska L, "Membranous nephropathy associated with thyroid disorders", Nephron, 86, pp.534~535 (2000)
- Salomon MI, "Renal lesions in hypothyroidism: a study based on kidney biopsies", Metabolism, 16, pp.846~852 (1967)
- Jordan SC, "Studies of immune-complex glomerulonephritis mediated by human thyroglobulin", N Engl J Med, 304, pp.1212~1215 (1981)
- Shankland SJ, "New insights into the pathogenesis of membranous nephropathy", Kidney Int, 57, pp.1204~1205 (2000)
- Gurkan S, "A case of autoimmune thyroiditis and membranoproliferative glomerulonephritis", Pediatr Nephrol, 24, pp.193~197 (2009)
- Pratt DE, "The association of antithyroid antibodies in euthyroid nonpregnant women with recurrent first trimester abortions in the next pregnancy", Fertil Steril, 60, pp.1001~1005 (1993)
- Montenegro J, "Changes in renal function in primary hypothyroidism", Am J Kidney Dis, 27, pp.195~198 (1996)