Endocrine dysfunction in the nephrotic syndrome
- Jai Radhakrishnan, MD, MS
Jai Radhakrishnan, MD, MS
- Professor of Medicine
- Columbia University Medical Center
- Section Editors
- Richard J Glassock, MD, MACP
Richard J Glassock, MD, MACP
- Editor-in-Chief — Nephrology
- Section Editor — Glomerular Diseases
- Emeritus Professor
- The David Geffen School of Medicine at UCLA
- Fernando C Fervenza, MD, PhD
Fernando C Fervenza, MD, PhD
- Section Editor — Glomerular Diseases
- Professor of Medicine
- Mayo Clinic College of Medicine
The nephrotic syndrome is characterized by a marked increase in the glomerular permeability to macromolecules. The associated urinary losses of albumin and hormone-binding proteins are responsible for many of the metabolic derangements and endocrine abnormalities in these patients .
This topic review will emphasize the alterations in thyroid, vitamin D, and calcium metabolism. The effects on lipid metabolism are discussed elsewhere. (See "Lipid abnormalities in nephrotic syndrome".)
THYROID FUNCTION TESTS
Thyroid function tests reveal variable results in the nephrotic syndrome, primarily depending upon the level of protein losses in the urine. In addition, other factors that are frequently present in patients with the nephrotic syndrome, such as hypoalbuminemia, increased serum free fatty acid concentrations, and furosemide administration, can also affect thyroid function tests [2-4]. (See "Laboratory assessment of thyroid function".)
Although there are no data, it is reasonable to test thyroid function when nephrotic syndrome is first diagnosed, and then perform serial testing (at least annually) in patients who remain nephrotic.
Relatively normal glomerular filtration rate — Urinary losses of thyroxine (T4)-binding globulin (TBG) and other thyroid hormone-binding proteins (transthyretin and albumin) and the T4 bound to them result in a low total T4 concentrations in approximately 50 percent of nephrotic patients with a relatively normal glomerular filtration rate (GFR) [5-7]. Serum triiodothyronine (T3) concentrations may also be low due also to decreased binding. There is often a good correlation between the serum T4 and T3 and the serum albumin concentration . Serum reverse T3 (rT3) concentrations are also low.
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