Renal dysfunction caused by severe hypothyroidism diagnosed by renal biopsy: a case report.

IF 1 Q4 UROLOGY & NEPHROLOGY CEN Case Reports Pub Date : 2024-10-01 Epub Date: 2024-02-28 DOI:10.1007/s13730-024-00853-7
Hiroki Tani, Shuma Hirashio, Akihiro Tsuda, Yoshiro Tachiyama, Shigeo Hara, Takao Masaki
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Abstract

There is a close relationship between thyroid dysfunction and renal dysfunction. However, thyroid dysfunction can unfortunately result in inaccurate measurements of serum creatinine and cystatin C levels. The chronic decrease in cardiac output due to hypothyroidism can reduce renal plasma flow (RPF) resulting in renal dysfunction. We report the case of a 36-year-old male in whom renal dysfunction detected during a company health check-up was found to be caused by severe hypothyroidism. His serum creatinine levels showed poor results, but serum cystatin C levels were within the normal range. The physician thus prioritized serum cystatin C for assessing the patient's renal function, and concluded that his renal function was normal. He subsequently visited our hospital, aged 36 years, for a comprehensive examination. His serum creatinine level was 1.88 mg/dL and his serum cystatin C level was 0.75 mg/dL, indicating an unusual discrepancy between the two measurements. The patient also presented with fatigue, suggesting hypothyroidism, and we therefore evaluated his thyroid function. His free thyroxine level was below the sensitivity of the assay, while his thyroid-stimulating hormone level was > 100 μIU/mL. A renal biopsy was performed to further explore the underlying cause of his renal dysfunction, which suggested that reduced RPF could be the leading cause of his renal ischemia, with no indications of chronic glomerulonephritis or other abnormalities. His hypothyroidism and renal function improved after thyroid hormone replacement therapy. Given the limited reports of renal biopsy tissue examination during the acute phase of hypothyroidism, the current case provides important information regarding the diagnosis of renal dysfunction in patients with hypothyroidism.

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通过肾活检确诊的严重甲状腺功能减退症导致的肾功能障碍:病例报告。
甲状腺功能障碍与肾功能障碍之间有着密切的关系。但遗憾的是,甲状腺功能障碍会导致血清肌酐和胱抑素 C 水平的测量结果不准确。甲状腺功能减退症导致的长期心输出量减少会降低肾血浆流量(RPF),从而导致肾功能障碍。我们报告了一例 36 岁男性的病例,他在一次公司体检中被查出患有严重的甲状腺功能减退症,导致肾功能障碍。他的血清肌酐水平显示不佳,但血清胱抑素 C 水平在正常范围内。因此,医生在评估患者的肾功能时优先考虑了血清胱抑素 C,并得出了肾功能正常的结论。随后,他来到我院进行全面检查,当时他 36 岁。他的血清肌酐水平为 1.88 毫克/分升,而血清胱抑素 C 水平为 0.75 毫克/分升,表明这两个测量值之间存在不寻常的差异。患者还出现了疲劳症状,这表明他患有甲状腺功能减退症,因此我们对他的甲状腺功能进行了评估。他的游离甲状腺素水平低于检测灵敏度,而促甲状腺激素水平大于 100 μIU/mL。为了进一步探究他肾功能不全的根本原因,医生对他进行了肾活检,结果表明RPF降低可能是导致他肾缺血的主要原因,但没有慢性肾小球肾炎或其他异常的迹象。在接受甲状腺激素替代治疗后,他的甲状腺功能减退症和肾功能有所改善。鉴于有关甲减急性期肾活检组织检查的报道有限,本病例为诊断甲减患者的肾功能障碍提供了重要信息。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CEN Case Reports
CEN Case Reports UROLOGY & NEPHROLOGY-
CiteScore
1.90
自引率
0.00%
发文量
80
期刊介绍: Clinical and Experimental Nephrology (CEN) Case Reports is a peer-reviewed online-only journal, officially published biannually by the Japanese Society of Nephrology (JSN).  The journal publishes original case reports in nephrology and related areas.  The purpose of CEN Case Reports is to provide clinicians and researchers with a forum in which to disseminate their personal experience to a wide readership and to review interesting cases encountered by colleagues all over the world, from whom contributions are welcomed.
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