Department of Nephrology, Klinikum Stuttgart - Katharinenhospital, Stuttgart, Germany.
Department of Nephrology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
Pediatr Nephrol. 2022 Dec;37(12):3031-3042. doi: 10.1007/s00467-022-05640-z. Epub 2022 Jun 23.
Patients with non-dialysis-dependant chronic kidney disease (NDD-CKD) and dialysis-dependant chronic kidney disease (DD-CKD) frequently also suffer from thyroid disorders, especially hypothyroidism which is found two to five times more often among them compared to the general population. Emerging research has illustrated the potential prognostic implications of this association as NDD-CKD and DD-CKD patients with hypothyroidism have been shown to have higher mortality rates, and treatment of subclinical hypothyroidism in NDD-CKD patients has been reported to attenuate the decline of glomerular filtration rate over time. This review illustrates the bidirectional, multi-layered interplay between the kidneys and the thyroid gland explaining how pathologies in one organ will affect the other and vice versa. Additionally, it outlines the impact of thyroid disorders on routine parameters of kidney function (especially serum creatinine and serum cystatin C) that nephrologists should be aware of in their clinical practice. Lastly, it summarizes the emerging evidence from clinical studies on how treatment of subclinical hypothyroidism in NDD-CKD and DD-CKD patients may potentially have beneficial effects on kidney function as well as mortality. While most of the research in this area has been performed on adult patients, we specifically discuss what is currently known about thyroid dysfunctions in paediatric CKD patients as well and provide management suggestions. The evidence accumulated so far clearly indicates that further, prospective studies with meticulous methodology are warranted to refine our understanding of thyroid disorders in paediatric and adult CKD patients and establish optimal treatment pathways.
患有非透析依赖型慢性肾脏病（NDD-CKD）和透析依赖型慢性肾脏病（DD-CKD）的患者经常也患有甲状腺疾病，尤其是甲状腺功能减退症，其在这些患者中的发病率比普通人群高 2 至 5 倍。新兴研究表明了这种关联的潜在预后意义，因为患有甲状腺功能减退症的 NDD-CKD 和 DD-CKD 患者的死亡率更高，并且据报道，NDD-CKD 患者亚临床甲状腺功能减退症的治疗可随时间推移减缓肾小球滤过率的下降。本篇综述说明了肾脏和甲状腺之间的双向、多层次相互作用，解释了一个器官的病理如何影响另一个器官，反之亦然。此外，它概述了甲状腺疾病对肾功能常规参数（尤其是血清肌酐和血清胱抑素 C）的影响，肾病学家在临床实践中应该注意这些参数。最后，它总结了关于 NDD-CKD 和 DD-CKD 患者亚临床甲状腺功能减退症治疗可能对肾功能和死亡率产生潜在有益影响的临床研究中的新证据。虽然该领域的大部分研究都是针对成年患者进行的，但我们特别讨论了目前已知的儿科 CKD 患者甲状腺功能障碍的情况，并提供了管理建议。迄今为止积累的证据清楚地表明，需要进一步进行前瞻性研究，采用严谨的方法，以完善我们对儿科和成年 CKD 患者甲状腺疾病的认识，并确定最佳治疗途径。
