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Jun 2016 DOI 10.14302/issn.2574-4488.jna-16-1008
Background: It is unclear whether patients who present with elevated blood urea nitrogen (BUN), but are normal for other markers of kidney damage, are prone to develop chronic kidney disease (CKD). This study therefore investigated estimated glomerular filtration rate (eGFR), a marker of CKD, in these patients. Methods: Patients with elevated BUN but normal for other markers of kidney damage who were followed-up for ≥48 months in our outpatient clinics were retrospectively evaluated. BUN, eGFR, and serum creatinine concentrations in the patient group were compared with findings in an age- and sex-matched control group. Results: At baseline, BUN concentration was significantly higher in the patient than that in the control group (8.30±1.10 vs 5.05±0.91 mmol/L; p <0.01), but eGFR (111.94±18.62 vs 111.25±14.63 ml/min/1.73m2) and serum creatinine concentrations (87.23±8.59 vs 72.39±10.06 µmol/L) were similar. At 1 year, however, eGFR in the patient group was significantly lower than in the control group (95.39±18.52 vs 108.17±16.99 ml/min/1.73m2; p < 0.01), and was significantly lower than in the patient group at baseline (95.39±18.52 vs 111.94±18.62 ml/min/ 1.73 m2, p < 0.01), with these differences becoming more pronounced over time. Conclusions: Patients with elevated BUN but normal for other markers of kidney damage show significantly lower eGFR over time than matched controls.
Feb 2022 DOI 10.14302/issn.2574-4488.jna-21-4039
The function of the thyroid gland is one of the most important in the human body as it regulates the majority of the body's physiological actions. The thyroid produces hormones (T3 and T4) that have many actions including metabolism, development, protein synthesis, and the regulation of many other important hormones. There is a lot of interaction between the kidney and thyroid gland during the disease States thyroid hormones have a major role in regulating the glomerular filtration rate through its hormonal actions in normal physiology. But these things are altered in the disease States such as chronic kidney disease. It is a well-known fact that hypothyroidism causes decreased Glomerular filtration rate whereas hyperthyroidism causes increased Glomerular filtration rate leading to renin-angiotensin-aldosterone system activation. In our study we aim to see the prevalence of low T3 syndrome in different stages of CKD which is a state of physiological benefit in preserving the proteins lost through the Kidneys in CKD patients and since CKD is progressed in hyperthyroidism state it is a protective mechanism in restoring the CKD status. Other subclinical hypothyroidism hyperthyroidism. Autoimmune hypothyroidism. Glomerulonephritis are all part of a dynamic endocrine and nephrology sequence. Thorough knowledge of these is required for optimum treatment of thyroid in CKD patients.
Dec 2015 DOI 10.14302/issn.2372-6601.jhor-14-397
Immunotactoid glomerulopathy (ITG) is a rare cause of chronic kidney disease (CKD) and end-stage-renal-disease (ESRD). It is often associated with monoclonal gammopathy and/or hematologic malignancy. We report a patient originally diagnosed with ITG in 1998. He presented with nephrotic-range proteinuria, hypertension, and a gradual decline in glomerular filtration rate. A published case report of this patient at the time the disease was originally diagnosed described only a small peak of IgM paraprotein without lymphoma or plasma cell dyscrasia. He was diagnosed with monoclonal gammopathy of unknown significance. He later developed ESRD and initiated hemodialysis in 2004. Fourteen years after the diagnosis of ITG and MGUS was made he developed headache, lymphadenopathy, borderline splenomegaly, thrombocytopenia, and coagulopathy. Workup revealed a very high level of monoclonal IgM-kappa (4390 mg/dL),and low grade B-cell lymphoma, consistent with lymphoplasmacytic lymphoma, leading to a diagnosis of Waldenstrom’s macroglobulinemia (WM). He died shortly thereafter of complicated gram-negative sepsis. To our knowledge this is the first report of WM associated with ITG. The patient's course illustrates that plasma cell dyscrasia and lymphoma can present many years after the original diagnosis of ITG is made and that continued vigilance for these conditions is warranted.