Evaluation of Thyroid Hormone Status in Children with Steroid Resistant Nephrotic Syndrome: A North India Study.

Background: Steroid resistant nephrotic syndrome (SRNS) has a chronic and progressive course. Limited data is available evaluating thyroid function parameters in SRNS patients. The aim of the present study was to evaluate the thyroid hormone status in Indian children with SRNS.
Materials & Methods: The present cross-sectional study included 50 patients aged 1-12 years with SRNS. As per Up:Uc ratio divided into three groups: Group A) 16 patients of SRNS in complete remission Group B) 14 patients of SRNS in partial remission Group C) 20 patients of SRNS in relapse. Serum levels of FT3, FT4 and TSH were measured in all.
Results: 20% of the children (n=10) with SRNS had hypothyroidism (7 subclinical hypothyroidism and 3 with overt hypothyroidism). One child was found to be in complete remission, 4 in partial remission and 5 in relapse phase. TSH levels were found to be significantly elevated in children with relapse (p = 0.042). Serum albumin showed a significant negative correlation with Up:Uc ratio ( p < 0.0001) whereas total cholesterol showed a significant positive correlation (p < 0.001). On correlating TSH level with Up:Uc ratio a significant positive correlation ( p = 0.0098) was observed.
Conclusion: Subclinical hypothyroidism in SRNS is temporary and may improve with remission. However prolonged proteinuria in SRNS patients may lead to progressive damage of the renal tubules and impaired absorption of Low Molecular Weight (LMW) proteins which may further exhaust the thyroid reserve and lead to overt hypothyroidism. Therefore thyroid examination should be routinely advocated in these children.