Valentín M, Bueno B, Gutiérrez E, Martínez A, González E, Espejo B, Torres A
Servicio de Nefrología, Hospital 12 de Octubre, Madrid.
Nefrologia. 2004;24 Suppl 3:43-8.
Several cases of glomerular disease have been associated to thyroid diseases. The most frequent lesion described is membranous glomerulopathy, presented as a nephrotic syndrome. Here we report a 67-year-old man who developed a nephrotic syndrome accompanied by rapid derangement of renal function shortly after the onset of a primary hypothyroidism due to autoimmune thyroiditis. High titers of circulating anti-thyroglobulin and anti-microsomal thyroid antigen antibodies were detected. Serum levels of C3 and C4 fractions of complement were markedly decreased. Renal biopsy showed a membranoproliferative glomerulonephritis with severe mesangial proliferation, a type of glomerular involvement non-described previously in the literature, in relation with thyroid diseases. Four boluses of intravenous steroids were administered, followed by oral prednisone for three months. A dramatic recovery of renal function, together with normalization of urinary sediment, proteinuria decrease and normalization of serum complement were observed. Three years later, the patient suffered from a similar event, with a positive response to steroids again. One year later, the patient had a new recurrence and was treated with mycophenolate mofetil , improving his clinical situation.
已有数例肾小球疾病与甲状腺疾病相关。所描述的最常见病变是膜性肾小球病，表现为肾病综合征。在此，我们报告一名67岁男性，在因自身免疫性甲状腺炎导致原发性甲状腺功能减退症发病后不久，出现了肾病综合征并伴有肾功能迅速紊乱。检测到高滴度的循环抗甲状腺球蛋白和抗微粒体甲状腺抗原抗体。补体C3和C4组分的血清水平显著降低。肾活检显示为膜增生性肾小球肾炎伴严重系膜增生，这是一种此前文献中未描述过的与甲状腺疾病相关的肾小球受累类型。给予四次静脉注射类固醇，随后口服泼尼松三个月。观察到肾功能显著恢复，同时尿沉渣正常化、蛋白尿减少以及血清补体正常化。三年后，患者发生了类似事件，再次对类固醇治疗反应良好。一年后，患者再次复发，接受霉酚酸酯治疗，临床状况有所改善。
