About connection of clinical manifestations of glomerulonephritis with features of the thyroid status of patients

BACKGROUND: There are four clinical variants of glomerulonephritis (GN) - urinary (latent), hypertensive, nephrotic and mixed. It was found that the features of clinical manifestations of GN that determine its clinical variant do not depend on the etiology, pathogenesis and morphological form of the disease. Taking into account the obtained data on the association of nephrotic syndrome with hypofunction of the thyroid gland, we suggested, that the formation of clinical variants of GN may be influenced by the features of the thyroid status of patients.

AIM: Study the relationship of variants of clinical manifestations of GN with indicants of thyroid status.

MATERIALS AND METHODS: The study included patients with primary GN who received in-treatment in the nephrology unit of a general hospital. Patients were selected into 4 groups depending on the clinical variant of GN (urinary, nephrotic, hypertensive and mixed variants). When selecting patients, we achieved comparability of groups by age, gender, morphological variants and duration of the disease. In addition to the generally accepted methods of research, patients were performed: 1) assessment of the thyroid status (thyroid-stimulating hormone (TSH), free thyroxine (free T4), free triiodothyronine (free T3), antibodies to thyroperoxidase (anti-TPO), (free T3+free T4)/TSH, free T4/free T3, free T4/TSH); 2) determination of levels of interleukin - IL-1β, IL-4 and IL-10 in blood serum; 3) ultrasound (US) examination of the thyroid gland. The obtained data were compared with those of healthy people.

RESULTS: The group of patients with the nephrotic variant of GN in 50% of cases showed a decrease of the level of free Т4 with the increase of TSH level, 26.7% showed a moderate increase of TSH at unchanged concentrations of free Т4 and free T3. In patients with the urinary variant of GN, the thyroid status did not differ from that in healthy patients, and the cytokine profile was characterized by a simultaneous increase in the content of the proinflammatory cytokine IL-1β and the anti-inflammatory cytokine IL-10. The group of patients with the hypertonic variant of GN in 82% of cases showed an isolated increase in TSH content. In the group of patients with a mixed variant of GN, changes in thyroid indices were predominant, combined with a large variability in the level of IL-1β production.

CONCLUSIONS: The results of the study indicate the influence of the functional state of the pituitary-thyroid system on the formation of different clinical variants of GN, which depends mainly on the level of production of the anti-inflammatory cytokine IL-10.

thyroid status, glomerulonephritis, cytokines, euthyroid sick syndrome

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