Hypothyroidism in Children with Steroid-Resistant Nephrotic Syndrome and its Correlation with Clinicopathological Parameters at a Tertiary Care Center in Pakistan

Abstract

Objective: To find out the frequency of hypothyroidism in steroid-resistant nephrotic syndrome children and to correlate thyroid hormone status with laboratory parameters. Methods: The study was carried out at Pediatric Nephrology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan from July 2019 to July 2020. In all, 73 children (1-18 years) with steroid-resistant nephrotic syndrome were enrolled. Their demographic, laboratory and histopathological data including thyroid hormone profile at diagnosis were recorded. Clinicopathological features of hypothyroid and euthyroid children were compared. Thyroid profiles of hypothyroid children at diagnosis and after 3 months of immunosuppressive therapy were compared and 3-month profiles were also correlated with degree of proteinuria/response to treatment. Statistical analysis was performed by SPSS version 20.0. Results: Of 73 children, 20 (27%) were hypothyroid: 18 (90%) subclinical and 2 (10%) with overt hypothyroidism at diagnosis. None of these had anti-thyroid antibodies or abnormal findings on ultrasound. At end-point, 3/20 (15%) were lost to follow up. Of remaining 17 children, 6 (35%) patients who achieved remission of proteinuria had normal thyroid hormones and among the remaining 11 (65%) patients with persistent proteinuria, 6/11 (54.5%) had normal thyroid stimulating hormone values, 4/11 (36.4%) had subclinical hypothyroidism while only one patient (9%) had overt disease. A statistically significant correlation was observed between the thyroid hormones, degree of proteinuria, low serum albumin and high cholesterol. Conclusion: Hypothyroidism was observed in nearly one third sizeable of children with steroid-resistant nephrotic syndrome. Persistent proteinuria may lead to subclinical or overt hypothyroidism, necessitating monitoring of thyroid function tests.