Membranous glomerulonephritis secondary to Hashimoto's thyroiditis
Glomerulonefritis membranosa secundaria a tiroiditis de Hashimoto
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"apellidos" => "Molina Miguel" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Sección de Nefrología, Hospital Universitario Río Hortega, Valladolid, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Glomerulonefritis membranosa secundaria a tiroiditis de Hashimoto" ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor, </span></p><p class="elsevierStylePara">Thyroid pathology has a high prevalence in the general population, although autoimmune aetiology is rare. It is associated with a variety of glomerulonephritis types in very few cases, the most frequent being membranous glomerulonephritis.<span class="elsevierStyleSup">1,2</span> We present a case of membranous glomerulonephritis secondary to Hashimoto's thyroiditis.</p><p class="elsevierStylePara">We present the case of a woman aged 66, admitted to our department with proteinuria, generalised oedemas and new-onset hypertension, resistant to prescribed treatment. Analytical tests showed: urea 78mg/dl, creatinine 1.1mg/dl; MDRD-4 formula creatinine clearance 48ml/min; total proteins 4.6g/dl; albumin 1.2g/dl. Protein profile compatible with nephrotic syndrome. Cholesterol: 484mg/dl. Triglycerides: 180mg/dl. LDL: 386mg/dl. Autoimmunity and complement within normal ranges. Negative circulating immune complexes. TSH: 10.17mU/l, T4: 0.78mg/dl. Anti-microsomal antibodies: 84U/ml. Antithyroglobulin antibodies: 4U/ml. Anti-TSH receptor antibodies: 1.6U/l. Proteinuria to 10g/24 hours. An ultrasound-guided renal biopsy was performed with an anatomopathological result of membranous glomerulonephritis. The gynaecological study was normal, as was the abdominal ultrasound and the thoracic-abdominal-pelvic CT scan. Membranous glomerulonephritis probably secondary to Hashimoto's thyroiditis was diagnosed and treatment with levothyroxine, statin and dual blockade of the renin-angiotensin system was commenced.</p><p class="elsevierStylePara">During follow-up, treatment had to be suspended with ACE inhibitors due to intolerance, despite which there was a progressive decline in proteinuria up to values of 1.5g/24 hours after 6 months of hormonal treatment, and TSH, T3 and T4 figures normalised.</p><p class="elsevierStylePara">Hashimoto's thyroiditis treatment is not clear; hormone substitution therapy is recommended in cases of thyroiditis with clinical repercussion, although there is no clear consensus in the subclinical cases.<span class="elsevierStyleSup">3</span> Our case shows how normalisation of the thyroid hormone values by administering levothyroxine has a linear repercussion in relation to the proteinuria detected. Even so, not all the cases described present this relationship.<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara">Lastly, we deem it necessary, as other authors have stated, to perform an analysis of the thyroid hormones in every patient with nephrotic syndrome as part of an aetiological screening process.<span class="elsevierStyleSup">5</span></p>" "pdfFichero" => "P1-E503-S2294-A10493-EN.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Verger MF, Droz D, Vantelon J. Maladies thyroïdiennes autoinmunes associées à une néphropatie glomérulaire. Presse Med 1983;12:83-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/6221320" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Taniguchi Y, Yorioka N, Katsutani M, Nagano R, Yokuyama R, Okubo M, et al.\u{A0}Hemophagocytic syndrome in a patient with Hashimoto¿s thyroiditis and membranous nephritis. Nephron 1999;1:246-7." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "3.\u{A0}Foz Sala M,\u{A0}Lucas Martín A, et al. Enfermedades del tiroides. Medicina Interna. En: Farreras-Rodman (eds.).\u{A0}Décimocuarta edición; vol II, 2357-8." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "4.\u{A0}Rodríguez P,\u{A0}Gómez Campderá FJ,\u{A0}García de Vinuesa MS,\u{A0}Niembro E,\u{A0}Rodríguez M,\u{A0}Luño J, et al.\u{A0}Nefropatía membranosa asociada a tiroiditis autoinmune. Nefrologia 1996;16(6)558-61." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "5.\u{A0}Peña Porta JM,\u{A0}González Igual J,\u{A0}Vicente de Vera Floristán C.\u{A0}Tiroiditis autoinmune, hipotiroidismo subclínico y síndrome nefrótico por nefropatía membranosa. Nefrologia 2008;28(5):572-3. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18816231" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003000000005/v0_201502091651/X2013251410050540/v0_201502091651/en/main.assets" "Apartado" => array:4 [ "identificador" => "35437" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor - Brief Case Reports" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003000000005/v0_201502091651/X2013251410050540/v0_201502091651/en/P1-E503-S2294-A10493-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251410050540?idApp=UINPBA000064" ]
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