Change Of Urinary Iodine And Blood Thyroid Hormone In Patients Suffer From Primary Nephritic Syndrome

Objective: Nephrotic syndrome is a kind of syndrom whoes clinicalfeatures are massive proteinuria, hypoalbuminemia, hypercholesterolemia,edema.According to etiology,Nephrotic syndrome can be divided into primaryand secondary two classes. The disease of primary NS are differentpathological types of glomerular disease, which common with minimal changenephropathy, mesangial proliferative glomerulonephritis, focal segmentalglomerulosclerosis,membranous nephropathy, mesangiocapillary glomeru-lonephritis.In childhood,90%nephrotic syndrome is primary nephriticsyndrome.The incidence rate of children PNS years report in foeigen is about2~4/10million, the prevalence rate is16/10million,children hospitalized instatistics show that the proportion of PNS is21%to31%in pediatric hospitalurinary system diseases in children in part of hospital in china.At present, thepathogenesis of nephrotic syndrome is not yet clear, there are report aboutserum iron,zinc, copper levels are reduced in nephropathy syndrome, but nostudy on iodine in nephrotic syndrome; there are also reports in the literatureof nephrotic syndrome in children with changes in thyroid function but notconclusive. Thyroid and kidney are closely related, when renal function isimpaired, the secretion, metabolism and excretion of thyroid hormone wouldchange. Thyroid hormone is one of the most closely hormone related to sugarfat and protein and play an important role in the growth,development andmaturation of kidney. The normal level of thyroid hormone can promote thesynthesis and gluconeogenesis, promoting cholesterol degradation andexcretion, induced protein synthesis, promote sodium and water excretionfrom the kidney,promote appetite and enhance digestion and absorptionfunction. Thyroid hormone deficiency can cause glomerular, tubular basementmembrane thickening and endothelial cells, mesangial cell proliferating, capillary permeability increasing,so that the glomerular filtration rate andrenal plasma flow reduce.In the blood, thyroid hormone is divided into freeand bound two forms and keep balance. In bound,10%combined with albumin,15%combined with thyroid binding protein, and75%combined withthyroxine-binding globulin. Nephrotic syndrome patients with heavyproteinuria, except plasma albumin reduced from urine, thyroxine-bindingglobulin also can be reduced from urine. Thyroxine-binding globulin decreasewill lead to total T3, T4decreased, or thyroid hormones directly loss fromurine leads to abnormal thyroid function, which secondary to the change ofFT3, FT4. By detecting the urine iodine and serum FT3, FT4, TSH changes inacute and remission period children and the correlation with urinary protein,understanding the iodine metabolism and thyroid function in children, andproviding a better basis for nephrotic syndrome pathogenesis and treatment.Methods:1Research subjects: the nephrotic syndrome children are treated in ourhosptial between2012.6and2013.3.The children are in line with thediagnostic criteria of nephrotic syndrome made by The Chinese MedicalAssociation Pediatrics Branch Kidney Group: proteinuria, urinary protein+++~++++three times a week;24hours urinary protein≥3.5g/d;low serumalbumin, serum albumin <30g/L;hyperlipidemia, plasma cholesterol>5.7mmol/L;edema.At the same time, eliminate all sorts of secondary factorssuch as diabetic nephropathy, hepatitis Bvirus associated glomerulonephritis,purpura nephritis, lupus nephritis.2Test methods and grouping2.1Test index and methodTake24hours urine (the method is row away the urine before eighto’clock and mix evenly all of the urine include the urine at eight o’clock innext morning,before detection we should amount the volume of the urine thentake100ml from them for detection.At last,according to the actual volume ofurine calculate the24hours urine protein).Before the day children can not eathigh iodine food such as laver and kelp and drugs containing iodine.Testing24 hours urine iodine in trace element chamber and24hours urine protein inbiochemical laboratory.Also blood2ml detect serum FT3,FT4,TSH inendocrine laboratory in our hosptial.2.2Grouping and research schemeAccording to whether the urine protein turn negative,the observationgroup are divided into acute stage group and remission stage group and20cases in earch group,the control group are20healthy children.Analysis the urine iodine and the changes of seurm FT3,FT4,TSH inchildren with primary nephrotic syndrome in actue and remission period andthe correlation with urinary protein by SPSS tool. P<0.05has statisticalsignificance.Results: Serum FT3, FT4and urine iodine (1.79±0.66pmol/L,6.21±1.56pmol/L,66.32±16.85μg/l) in actue stage group are lower than controlgroup(4.60±1.13pmol/L,18.85±2.69pmol/L,107.85±7.17μg/l),TSH(8.81±2.62mIU/L) is higher than the control group(2.25±0.86mIU/L).There are nosignificant difference of serum FT3(4.26±0.76pmol/L),FT4(19.12±1.09pmol/L),TSH(2.19±0.85mIU/L)and urine iodine(106.11±6.99μg/l)betweenthe remission stage group and the control group.Serum FT3,FT4and urineiodine (r=-0.849,-0.899,-0.86P<0.01)in actue stage group are negativelycorrelated with urine protein,but TSH(r=0.917P<0.01)is positively correlatedwith urine protein.Conclusion: Children with primary nephrotic syndrome at actue stagehave thyroid hypofuction,FT3, FT4and urinary iodine concnetrationdecreased but TSH increased.There is no obvious difference in thyriodfunction and urine iodine between remission stage children and normalchildren. Primary nephrotic syndrome in children have FT3, FT4, urinaryiodine concnetration decrease and TSH increase in acute period, and FT3, FT4and urinary iodine are negatively correlated with urinary protein,but TSH arepositively correlated with urinary protein; in remission stage There is noobvious difference in thyriod function and urine iodine between remissionstage children and normal children.If the children get better, the urine protein will turn negative, serum levels of thyroid hormones will recover.