Study On The Dependablity Of Autoimmune Thyroid Diseases And Kidney Disease

Objective: With the continuous improvement of diagnostic techniques, the diagnosis of autoimmune thyroid diseases(AITD)gradually improve. It’s found that the serum degrees of thyroid peroxidase antibody(TPOAb) and/or thyroglobulin antibody(TGAb) increase significantly and often accompanys by varying degrees of damage to other organs. Abroad in the early 1950 s, it was reported that patients with AITD may be accompanied by proteinuria. Then some scholars put forward the relevant report, saying it for AITD associated nephrotic syndrome(AITD-N). Is AITD merging with kidney damage usually the sign of different visceral injury in the same kind of autoimmune disease or does AITD itself cause the damage to the kidney? If AITD caused kidney damage,What is the mechanism? At present there is no exact answer to the above questions. Now it’s found that the serum levels of interferon induced protein 10(IP- 10) are higher in patients newly diagnosed with chronic autoimmune thyroiditis than in those of non- autoimmune thyroid disease, while the study found that IP- 10 activation of Th1 cells can cause tissue damage. Dose the IP-10 and its receptor CXC chemokine receptor 3(CXCR3) also plays a role in kidney damage? This team collects clinical cases associated with proteinuria and renal biopsy of kidney disease, observes the prevalence of AITD,compares renal biochemical index in the patients of AITD within the patients of non-AITD, and deals with the kidney tissues of two groups of patients with AITD specific antigen——TPO, TG, immunohistochemical staining.Then This team observes whether there is a corresponding specific antigen in the kidney. This team deals with the kidney tissues of two groups of patients with receptor CXCR3 immuno Histochemical staining, To further explore the mechanism of AITD may cause kidney damage.Methods: This team collects 96 cases of hospitalized patients with positive urine protein in renal medicine and 24 hours urinary protein is greater than 0.5 g. Patients suffer kidney biopsy after admission. Pathologic specimens are done immunofluorescence, light microscope, electron microscope examination.We gather all of the patients medical history, clinical manifestations, signs, conventionallaboratory methods check the 24 h urine protein quantitative, albumin, blood urea nitrogen(BUN), serum creatinine(SCr), determination of glomerular filtration rate(GFR)and test for serum TT3, TT4, FT3, FT4, thyroid-stimulating hormone(TSH), TGAb, TPOAb, complement C3, C4, serum Ig A, Ig M and Ig G. We analyze serum TPOAb and/or TGAb positive incidence of patients in the urine protein in patients with kidney disease and divide into AITD, non AITD group according to whether the serum TGAb and/or TPOAb is positive. AITD group of renal biopsy in patients with pathological type, the characteristics of patients with glomerular histochemical staining TPO, TG positive rate are analyzed.Whether BUN, SCr,GFR, 24 h urine protein quantitative, complement C3, C4, serum Ig A, Ig M, Ig G,FT3, FT4, TSH, TGAb, TPOAb, IP10, CXCR3 between two groups of patients are different. Observing two groups of kidney TPO, TG immunohistochemical study whether there is a difference.Observing two groups of kidney CXCR3 immunohistochemical study whether there is a difference.Results: 1. AITD prevalence was 9.47% in patients with urinary protein that is greater than 0.5 g / 24 h and renal biopsy of kidney disease, women for seven people, 77.78% of the number of AITD patients, 18.42% of women with renal biopsy, men for seven people, 22.22% of the number of AITD patients, 3.13% of men with renal biopsy; 2. AITD group and non- AITD comparison results:Age, gender difference is not obvious between two groups,and there is no statistical significance(P > 0.05); serum BUN, SCr and GFR and 24 h urine protein quantitative difference is not obvious between two groups,and there is no statistical significance(P > 0.05); Serum FT3, FT4, TSH difference is not obvious between two groups,and there is no statistical significance(P > 0.05); Serum C3, Ig A, Ig M difference is not obvious between two groups,and there is no statistical significance(P > 0.05); serum C4 of AITD group is under that of non- AITD group, the difference between the two groups is statistically significant(P < 0.05); serum Ig G of AITD is higher than that of non- AITD, the difference between the two groups is statistically significant(P < 0.05); 3. immunohistochemical results as follows: There is one case colorrde TPO staining in the kidney tissues of patients with AITD group. Color parts are in renal tubular, for focal color. Thereare four cases colorrde TG staining in the kidney tissues of patients with AITD group. Color parts are in renal tubular, including in glomerular color of two cases,for focal color. There are one cases colorrde CXCR3 staining in the kidney tissues of patients with AITD group. Color parts are in renal tubular and glomerular, for focal color.Conclusion: 1. Patients with kidney disease patients of greater than 0.5 g / 24 h urine protein, especially women, need to pay attention to the related parameters of AITD screening in order to early detection of AITD. 2. The difference of Serum BUN, SCr and GFR and 24 h urine protein quantitative is not obvious(P < 0.05) between AITD and non-AITD, it shows AITD could cause severe renal injury. 3. The difference of Serum FT3, FT4, TSH is not obvious(P < 0.05)between AITD and non-AITD,it shows there are other damage mechanism caused kidney damage in addition to the thyroid hormone disorder in AITD 4. The difference of Serum C3, Ig A, Ig M is not obvious between two groups(P > 0.05); serum C4 of AITD group is under that of non- AITD group, the difference is statistically significant(P < 0.05); serum Ig G of AITD is higher than that of non-AITD, the difference is statistically significant(P < 0.05), it shows in the AITD patient’s body there maybe a kind of mechanism activating complement and toning effect mediated by Ig G or there is a kind of Ig G correlation damage mechanism. 5. The renal tubules are colored in TPO and TG immunohistochemical of AITD group. Therefore, kidney damage may be associated with renal tubular damage. The glome- rulars also are colored in TG immunohistochemical of AITD group, therefore, the formation of immune complex may be one of the mechanisms of AITD correlation renal injury. 6. This research shows that renal tubules is colored in CXCR3 immunohistochemical of AITD group,So the effects of the chemokines may be one of the mechanisms to cause kidney damage.