Thyroid dysfunction and kidney disease

• Published in: European journal of endocrinology Vol. 160; no. 4; pp. 503 - 515
• Main Authors: Iglesias, P, Díez, J J
• Format: Journal Article
• Language: English
• Published: Bristol BioScientifica 01-04-2009
• Subjects: Animals; Antithyroid Agents - adverse effects; Antithyroid Agents - therapeutic use; Biological and medical sciences; Endocrinopathies; Fundamental and applied biological sciences. Psychology; Humans; Kidney - physiopathology; Kidney Diseases - complications; Kidney Diseases - physiopathology; Medical sciences; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Renal Dialysis; Review; Thyroid Diseases - complications; Thyroid Diseases - drug therapy; Thyroid Diseases - physiopathology; Thyroid Function Tests; Thyroid Gland - drug effects; Thyroid Gland - physiology; Thyroid Hormones - physiology; Thyroid. Thyroid axis (diseases); Vertebrates: endocrinology; Endocrinopathy; Kidney disease; Urinary system disease; Nephropathy; Thyroid function; Thyroid diseases; Endocrinology
• ISSN: 0804-4643; 1479-683X
• DOI: 10.1530/EJE-08-0837

Thyroid hormones (TH) are essential for an adequate growth and development of the kidney. Conversely, the kidney is not only an organ for metabolism and elimination of TH, but also a target organ of some of the iodothyronines' actions. Thyroid dysfunction causes remarkable changes in glomerular and tubular functions and electrolyte and water homeostasis. Hypothyroidism is accompanied by a decrease in glomerular filtration, hyponatremia, and an alteration of the ability for water excretion. Excessive levels of TH generate an increase in glomerular filtration rate and renal plasma flow. Renal disease, in turn, leads to significant changes in thyroid function. The association of different types of glomerulopathies with both hyper- and hypofunction of the thyroid has been reported. Less frequently, tubulointerstitial disease has been associated with functional thyroid disorders. Nephrotic syndrome is accompanied by changes in the concentrations of TH due primarily to loss of protein in the urine. Acute kidney injury and chronic kidney disease are accompanied by notable effects on the hypothalamus–pituitary–thyroid axis. The secretion of pituitary thyrotropin (TSH) is impaired in uremia. Contrary to other non-thyroidal chronic disease, in uraemic patients it is not unusual to observe the sick euthyroid syndrome with low serum triodothyronine (T3) without elevation of reverse T3 (rT3). Some authors have reported associations between thyroid cancer and kidney tumors and each of these organs can develop metastases into the other. Finally, data from recent research suggest that TH, especially T3, can be considered as a marker for survival in patients with kidney disease.