Clinico-immunological features of glomerulonephritis in children with thyroid hyperfunction

Abstract. Introduction. Children with chronic kidney disease often develop alterations of their endocrine system. The deficiency of thyroid hormones can lead to a worse prognosis in glomerulonephritis because these hormones influence the immune response and inflammatory processes in the kidneys. Aim. To study the influence of thyroid hyperfunction on the clinical manifestations of glomerulonephritis in children living in the Fergana Valley of the Republic of Uzbekistan, a region that was formerly endemic for goiter. Materials and Methods. This prospective study was based on clinical observations of children with glomerulonephritis and hyperthyroidism aged 3 to 15 years (n = 60) who were hospitalized in the nephrology department in the years of 2020–2024. Clinical - laboratory, instrumental, biochemical and immunological methods were used. The study assessed thyroid and renal functional parameters and immunological shifts. The data are presented as means (M) and standard deviations (SD), and as absolute (n) and relative (%) frequencies. Student’s t - test was used to determine the significance of differences between two mean values; qualitative variables were analyzed with Pearson’s χ2 test (differences were considered significant at p < 0.05). Results and Discussion. Among children with thyroid hyperfunction, there were acute glomerulonephritis with nephritic syndrome (41.9%) and the hematuric form of chronic glomerulonephritis (22.5%) identified. Correlation analysis showed a direct relationship between thyroid function indices and general and specific renal function parameters in children with glomerulonephritis and thyroid hyperfunction: Proteinuria correlated with free T3 (fT3), free T4 (fT4), and protein - bound iodine (PBI); hematuria correlated with fT3, fT4, and PBI; azotemia correlated with fT3, fT4, and PBI; daily urine output correlated with fT3, fT4, and PBI; and glomerular filtration correlated with fT3, fT4, and PBI. A direct correlation was also observed between immunological status indicators and thyroid status – namely between immunoglobulin classes and CD3+, CD4+ and CD8+ lymphocytes and fT3, fT4 and PBI – indicating the effect provided by thyroid on the immune reactivity of children with the nephrotic form of chronic glomerulonephritis. Conclusions. A significant influence of thyroid hormones on renal function was identified, suggesting that the thyroid gland was involved in the pathogenesis of glomerulonephritis. Given the identified characteristics of glomerulonephritis in children living in a goiter - endemic area, in cases of acute severe course, prognostically unfavorable clinical variants, persistent prolonged disease, or failure of therapy, thyroidal influence on disease progression should be considered.

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