title: Hypothyroidism in children with steroid-resistant nephrotic syndrome.
abstract: BACKGROUND
  Non-autoimmune hypothyroidism has been reported in children with congenital nephrotic syndrome. The hypothyroid state was attributed to massive prolonged thyroid hormone loss. However, this endocrine abnormality has not been reported in steroid-resistant nephrotic syndrome (SRNS) despite similar long-standing proteinuria.
  
  
  METHODS
  We describe all the patients with SRNS in our clinic's follow-up who developed non-autoimmune hypothyroidism.
  
  
  RESULTS
  Five children aged 3-11 years at diagnosis of SRNS and followed for 5-42 months developed hypothyroidism (depressed free thyroxin and elevated thyrotropin levels) without evidence of autoimmune thyroiditis. The diagnosis of hypothyroidism was not temporarily related to disease duration or renal function. The disease was resistant to all therapies, renal function deteriorated in all the patients within 1.5-14.5 years from diagnosis. Despite thyroxine treatment and a decline in renal function, thyroid hormone level normalized only after reaching end stage renal disease (ESRD) and hemodialysis start. Nephrotic syndrome recurrence after kidney transplantation (in three patients with focal segmental glomerulosclerosis) was not accompanied by recurrent hypothyroidism.
  
  
  CONCLUSIONS
  It is our impression that non-autoimmune hypothyroidism is a potential significant complication of SRNS, and should be actively sought for especially in cases with renal function deterioration. Hypothyroidism usually resolved when these patients reach ESRD. The incidence and pathogenesis of this condition require further study.
authors.affiliation: Institute of Nephrology, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel. DaganA@clalit.org.il
authors.forename: Amit
authors.initials: A
authors.lastname: Dagan
authors.forename: Roxana
authors.initials: R
authors.lastname: Cleper
authors.forename: Irit
authors.initials: I
authors.lastname: Krause
authors.forename: Danit
authors.initials: D
authors.lastname: Blumenthal
authors.forename: Miriam
authors.initials: M
authors.lastname: Davidovits
mesh_terms: D000893:Anti-Inflammatory Agents / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D004351:Drug Resistance; D005260:Female; D005923:Glomerulosclerosis, Focal Segmental / Q000150:complications* / Q000601:surgery; D006801:Humans; D007037:Hypothyroidism / Q000209:etiology* / Q000378:metabolism / Q000473:pathology; D007557:Israel / Q000453:epidemiology; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D009404:Nephrotic Syndrome / Q000150:complications* / Q000601:surgery; D011241:Prednisone / Q000494:pharmacology*; D011507:Proteinuria / Q000209:etiology; D012008:Recurrence; D013960:Thyroid Function Tests; D013967:Thyroiditis, Autoimmune / Q000188:drug therapy / Q000209:etiology; D013972:Thyrotropin / Q000378:metabolism; D013974:Thyroxine / Q000378:metabolism
chemical_list: D000893:Anti-Inflammatory Agents; D013972:Thyrotropin; D013974:Thyroxine; D011241:Prednisone