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Nagami GT, Kraut JA. The Role of the Endocrine System in the Regulation of Acid-Base Balance by the Kidney and the Progression of Chronic Kidney Disease. Int J Mol Sci 2024; 25:2420. [PMID: 38397097 PMCID: PMC10889389 DOI: 10.3390/ijms25042420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/07/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024] Open
Abstract
Systemic acid-base status is primarily determined by the interplay of net acid production (NEAP) arising from metabolism of ingested food stuffs, buffering of NEAP in tissues, generation of bicarbonate by the kidney, and capture of any bicarbonate filtered by the kidney. In chronic kidney disease (CKD), acid retention may occur when dietary acid production is not balanced by bicarbonate generation by the diseased kidney. Hormones including aldosterone, angiotensin II, endothelin, PTH, glucocorticoids, insulin, thyroid hormone, and growth hormone can affect acid-base balance in different ways. The levels of some hormones such as aldosterone, angiotensin II and endothelin are increased with acid accumulation and contribute to an adaptive increase in renal acid excretion and bicarbonate generation. However, the persistent elevated levels of these hormones can damage the kidney and accelerate progression of CKD. Measures to slow the progression of CKD have included administration of medications which inhibit the production or action of deleterious hormones. However, since metabolic acidosis accompanying CKD stimulates the secretion of several of these hormones, treatment of CKD should also include administration of base to correct the metabolic acidosis.
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Affiliation(s)
- Glenn T. Nagami
- Nephrology Section, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA;
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Jeffrey A. Kraut
- Nephrology Section, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA;
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
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Sangwan P, Srinivasan B, Janweja S, Jangid S. Anesthetic considerations in a parturient with renal tubular acidosis and hypothyroidism undergoing cesarean delivery. Int J Obstet Anesth 2017; 33:78-80. [PMID: 29029882 DOI: 10.1016/j.ijoa.2017.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 08/06/2017] [Accepted: 08/11/2017] [Indexed: 11/18/2022]
Abstract
Renal tubular acidosis, associated with hypothyroidism, is rare. We present the case of a woman with known renal tubular acidosis and treated hypothyroidism who underwent emergency cesarean delivery under uneventful combined spinal-epidural anesthesia. The rationale for choosing the anesthetic technique and the potential risks associated with anesthesia and renal tubular acidosis are discussed.
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Affiliation(s)
- P Sangwan
- Department of Anesthesia and Intensive Care, Dr. Sampurnanand Medical College, Jodhpur 342003, India.
| | - B Srinivasan
- Department of Anesthesia and Intensive Care, Dr. Sampurnanand Medical College, Jodhpur 342003, India
| | - S Janweja
- Department of Anesthesia and Intensive Care, Dr. Sampurnanand Medical College, Jodhpur 342003, India
| | - S Jangid
- Department of Anesthesia and Intensive Care, Dr. Sampurnanand Medical College, Jodhpur 342003, India
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Simeoni M, Cerantonio A, Pastore I, Liguori R, Greco M, Foti D, Gulletta E, Brunetti A, Fuiano G. The correct renal function evaluation in patients with thyroid dysfunction. J Endocrinol Invest 2016; 39:495-507. [PMID: 26511999 DOI: 10.1007/s40618-015-0402-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 10/17/2015] [Indexed: 10/22/2022]
Abstract
Thyroid dysfunction induces several renal derangements involving all nephron portions. Furthermore, dysthyroidism is a recognized risk factor associated with the development of chronic kidney disease. Current data, in fact, demonstrate that either subclinical or overt thyroid disease is associated with significant changes in creatinine, estimated glomerular filtration rate, measured glomerular filtration rate and Cystatin C. Herein, we systematically reviewed several relevant studies aiming at the identification of the most sensitive and specific parameter for the correct renal function evaluation in patients with thyroid dysfunction, that are usually treated as outpatients. Our systematic review indicates that estimated glomerular filtration rate, preferably with CKD-EPI equation, appears to be the most reliable and wieldy renal function parameter. Instead, Cystatin C should be better used in the grading of thyroid dysfunction severity.
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Affiliation(s)
- Mariadelina Simeoni
- Nephrology and Dialysis Unit, 'Magna Graecia' University, 88100, Catanzaro, CZ, Italy.
- University Campus 'Magna Graecia', Viale Europa-Loc. Germaneto, 88100, Catanzaro, Italy.
| | - Annamaria Cerantonio
- Nephrology and Dialysis Unit, 'Magna Graecia' University, 88100, Catanzaro, CZ, Italy
| | - Ida Pastore
- Endocrinology Unit, 'Magna Graecia' University, 88100, Catanzaro, CZ, Italy
| | - Rossella Liguori
- Endocrinology Unit, 'Magna Graecia' University, 88100, Catanzaro, CZ, Italy
| | - Marta Greco
- Clinical Pathology Unit, 'Magna Graecia' University, 88100, Catanzaro, CZ, Italy
| | - Daniela Foti
- Clinical Pathology Unit, 'Magna Graecia' University, 88100, Catanzaro, CZ, Italy
| | - Elio Gulletta
- Clinical Pathology Unit, 'Magna Graecia' University, 88100, Catanzaro, CZ, Italy
| | - Antonio Brunetti
- Clinical Pathology Unit, 'Magna Graecia' University, 88100, Catanzaro, CZ, Italy
| | - Giorgio Fuiano
- Nephrology and Dialysis Unit, 'Magna Graecia' University, 88100, Catanzaro, CZ, Italy
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Spahiu L, Jashari H, Mulliqi-Kotori V, Elezi-Rugova B, Merovci B. Hashimoto Thyroiditis and Nephrocalcinosis in a Child with Down Syndrome. Acta Inform Med 2016; 24:143-5. [PMID: 27147809 PMCID: PMC4851541 DOI: 10.5455/aim.2016.24.143-145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 03/16/2016] [Indexed: 11/07/2022] Open
Abstract
Introduction: Hypothyroidism has been reported to affect renal function and structure. However, the association of hypothyroidism with distal renal tubular acidosis (dRTA) is rarely reported in children. Case Presentation: We present a 6-year-boy with Down syndrome admitted in our department due to vomiting, weakness, polyuria, polydipsia, irritability and weight loss in the last few weeks. Investigations revealed features of hypokalemia, metabolic acidosis and alkaline urine consistent with dTRA. Abdominal ultrasound found nephrocalcinosis. In addition, Antithyroid peroxidase antibodies were positive, suggesting an autoimmune background for the pathogenesis of the tubular dysfunction. Treatment for dRTA and hypothyroidism was started and symptomatic improve was noticed. Conclusion: dRTA should be excluded in children with autoimmune disorders who develop weakness, polyuria, polydipsia or growth failure. Early diagnosis would reduce long-term complications.
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Affiliation(s)
- Lidvana Spahiu
- Pediatric Clinic, University Clinical Center of Kosovo, Pristina, Republic of Kosovo
| | - Haki Jashari
- Pediatric Clinic, University Clinical Center of Kosovo, Pristina, Republic of Kosovo; Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Vjosa Mulliqi-Kotori
- Pediatric Clinic, University Clinical Center of Kosovo, Pristina, Republic of Kosovo
| | - Blerta Elezi-Rugova
- Pediatric Clinic, University Clinical Center of Kosovo, Pristina, Republic of Kosovo
| | - Besart Merovci
- Pediatric Clinic, University Clinical Center of Kosovo, Pristina, Republic of Kosovo
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Wagner CA, Devuyst O, Bourgeois S, Mohebbi N. Regulated acid–base transport in the collecting duct. Pflugers Arch 2009; 458:137-56. [DOI: 10.1007/s00424-009-0657-z] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Revised: 02/22/2009] [Accepted: 02/24/2009] [Indexed: 02/07/2023]
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van Hoek I, Daminet S. Interactions between thyroid and kidney function in pathological conditions of these organ systems: a review. Gen Comp Endocrinol 2009; 160:205-15. [PMID: 19133263 DOI: 10.1016/j.ygcen.2008.12.008] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2008] [Revised: 12/02/2008] [Accepted: 12/03/2008] [Indexed: 11/25/2022]
Abstract
Thyroidal status affects kidney function already in the embryonic stage. Thyroid hormones influence general tissue growth as well as tubular functions, electrolyte handling and neural input. Hyper- and hypo-functioning of the thyroid influences mature kidney function indirectly by affecting the cardiovascular system and the renal blood flow, and directly by affecting glomerular filtration, electrolyte pumps, the secretory and absorptive capacity of the tubuli, and the structure of the kidney. Hyperthyroidism accelerates several physiologic processes, a fact which is reflected in the decreased systemic vascular resistance, increased cardiac output (CO), increased renal blood flow (RBF), hypertrophic and hyperplastic tubuli, and increased glomerular filtration rate (GFR). Renal failure can progress due to glomerulosclerosis, proteinuria and oxidative stress. Hypothyroidism has a more negative influence on kidney function. Peripheral vascular resistance is increased with intrarenal vasoconstriction, and CO is decreased, causing decreased RBF. The influence on the different tubular functions is modest, although the transport capacity is below normal. The GFR is decreased up to 40% in hypothyroid humans. Despite the negative influences on glomerular and tubular kidney function, a hypothyroid state has been described as beneficial in kidney disease. Kidney disease is associated with decreased thyroid hormone concentrations caused by central effects and by changes in peripheral hormone metabolism and thyroid hormone binding proteins. Geriatric cats form an animal model of disease because both hyperthyroidism and chronic kidney disease (CKD) have high prevalence among them, and the link between thyroid and kidney affects the evaluation of clinical wellbeing and the possible treatment options.
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Affiliation(s)
- Ingrid van Hoek
- Department of Medicine & Clinical Biology of Small Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
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Mohebbi N, Kovacikova J, Nowik M, Wagner CA. Thyroid hormone deficiency alters expression of acid-base transporters in rat kidney. Am J Physiol Renal Physiol 2007; 293:F416-27. [PMID: 17409279 DOI: 10.1152/ajprenal.00391.2006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Hypothyroidism in humans is associated with incomplete distal renal tubular acidosis, presenting as the inability to respond appropriately to an acid challenge by excreting less acid. Here, we induced hypothyroidism in rats with methimazole (HYPO) and in one group substituted with l-thyroxine (EU). After 4 wk, acid-base status was similar in both groups. However, after 24 h acid loading with NH(4)Cl HYPO rats displayed a more pronounced metabolic acidosis. The expression of the Na(+)/H(+) exchanger NHE3, the Na(+)-phosphate cotransporter NaPi-IIa, and the B2 subunit of the vacuolar H(+)-ATPase was reduced in the brush-border membrane of the proximal tubule of the HYPO group, paralleled by a lower abundance of the Na(+)/HCO(3)(-) cotransporter NBCe1 and a higher expression of the acid-secretory type A intercalated cell-specific Cl(-)/HCO(3)(-) exchanger AE1. In contrast to control conditions, the expression of NBCe1 was increased in the HYPO group during metabolic acidosis. In addition, net acid excretion was similar in both groups. The relative number of type A intercalated cells was increased in the connecting tubule and cortical collecting duct of the HYPO group during acidosis. Thus thyroid hormones modulate the renal response to an acid challenge and alter the expression of several key acid-base transporters. Mild hypothyroidism is associated only with a very mild defect in renal acid handling, which appears to be mainly located in the proximal tubule and is compensated by the distal nephron.
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Affiliation(s)
- Nilufar Mohebbi
- Institute of Physiology, University of Zurich, Winterthurerstrasse 190, CH-8057 Zurich, Switzerland
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Capasso G, De Santo NG, Kinne R. Thyroid hormones and renal transport: cellular and biochemical aspects. Kidney Int 1987; 32:443-51. [PMID: 2828744 DOI: 10.1038/ki.1987.231] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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9
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Brush Border and Basal-Lateral Membranes in the Action of Thyroid Hormone on the Proximal Tubule. Nephrology (Carlton) 1984. [DOI: 10.1007/978-1-4612-5284-9_33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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10
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De Santo NG, Capasso G, Paduano C, Carella C, Giordano C. Tubular transport processes in proximal tubules of hypothyroid rats. Micropuncture studies on isotonic fluid, amino acid and buffer reabsorption. Pflugers Arch 1980; 384:117-22. [PMID: 6446079 DOI: 10.1007/bf00584426] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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