甲状腺功能减退相关肾损伤患者的临床病理特征及预后  

Clinicopathological characteristics and prognosis of hypothyroidism-related renal impairment

作　　者：涂远茂 胡秀[2] 徐峰 刘霞 程震 TU Yuanmao;HU Xiu;XU Feng;LIU Xia;CHENG Zhen(National Clinical Research Center of Kidney Diseases,Jinling Hospital,Nanjing University School of Medicine,Nanjing 210016,China)

机构地区：[1]东部战区总医院,国家肾脏疾病临床医学研究中心,全军肾脏病研究所,南京210016 [2]德阳市人民医院肾内科

出　　处：《肾脏病与透析肾移植杂志》2022年第5期427-431,共5页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：江苏省临床医学研究中心项目(YXZXA2016003)。

摘　　要：目的:探讨甲状腺功能减退相关肾损伤(HRRI)患者的临床病理特征及预后。方法:回顾分析2009年1月至2020年12月期间在国家肾脏疾病临床医学研究中心行肾活检确诊为HRRI的病例,分析其临床表现、肾活检病理特点、治疗及预后。结果:共纳入18例患者,男性17例,平均年龄40.4±10.9岁。首诊主诉多为水肿(13例,72.2%)和血清肌酐(SCr)升高(4例,22.2%)。11例(61.1%)在发现肾脏损害后才确诊甲减。肾活检时SCr升高(140.6±18.6μmol/L),血清胱抑素C(Cys C)多正常(0.93±0.12 mg/L),仅1例超出正常上限;尿蛋白及尿红细胞基本阴性,尿N-乙酰-β-D-氨基葡萄糖苷酶(NAG)、视黄醇结合蛋白(RBP)均在正常范围。肾脏病理,以轻度急性肾小管间质病变为主,电镜观察肾小球病变多样,但多轻微且缺少特征性超微结构改变。所有患者接受甲状腺激素替代治疗后肾功能均有改善,估算的肾小球滤过率(eGFR)较基线升高>30%,肾功能改善的中位时间为2.7月。结论:原因不明肾功能损伤患者,应同时检测SCr及Cys C,并完善甲状腺功能检测以甄别HRRI。甲状腺激素替代治疗可显著改善HRRI患者的肾功能。Objective:To investigate the clinicopathological features and prognosis of hypothyroidism-related renal impairment(HRRI).Methodology:HRRI were diagnosed by renal biopsy from January 2009 to December 2020 in National Clinical Research Center of Kidney Diseases,Jinling Hospital.We reviewed the electronic medical records and summarized the clinical and pathological characteristics.Results:A total of eighteen cases of HRRI were included,with an average age of 40.4±10.9 years.Among these patients,17 were male.The most frequent chief complaint was edema(13 cases,72.2%),followed by increased serum creatinine(4 cases,22.2%).Hypothyroidism diagnosed after renal injury was found in 61.1%of patients.Baseline serum creatinine at renal biopsy was 140.6±18.6μmol/L.And serum cystatin C was 0.93±0.12 mg/L,which only one case was higher than the upper limit of normal.The proteinuria and hematuria were almost negative.N-acetyl-β-D-glucosidase and retinol-binding protein in the urine were all in normal range.Renal lesions were mild,mainly mild acute tubulointerstitial lesions.The glomerular lesions under electron microscope were various,but most of them were mild and lacked characteristic ultrastructural changes.After thyroid hormone replacement therapy,eGFR of all patients increased by more than 30%compared with baseline,and the median time of renal function improvement was 2.7 months.Conclusion:For unexplained renal impairment,checking serum creatinine and cystatin C levels stimultaneously time and detecting thyroid function were helpful to identify HRRI.Thyroid hormone replacement therapy significantly improved renal function in HRRI patients.When HRRI was highly suspected,THRT can be performed first,and then reassessed for renal biopsy.

关 键 词：肾功能损伤 甲状腺功能减退 肾脏病理 预后 

分 类 号：R581.2[医药卫生—内分泌] R692[医药卫生—内科学]