Thyroid function, renal function, and depression: an association study

Objective

To investigate the correlations between thyroid function, renal function, and depression.

Methods

Clinical data of 67 patients with Major depressive disorder (MDD) and 36 healthy control subjects between 2018 and 2021 were collected to compare thyroid and renal function. Thyroid and renal functions of depressed patients were then correlated with the Hamilton Depression Rating Scale (HAMD) and the Hamilton Anxiety Rating Scale (HAMA).Spearman correlation analysis was used to find the correlation between renal function, thyroid function, and depression. A logistic regression was performed to find significant predictors of depression.

Results

Triiodothyronine protamine (T3), thyroxine (T4), free triiodothyronine protamine (FT3), uric acid, sodium, and anion gap were lower in the MDD group than in the control group (p < 0.05). Correlation analysis of thyroid function, renal function, and factor terms of HAMD in the MDD group suggested that diurnal variation, hopelessness, and depression level were positively correlated with thyrotropin (TSH) (p < 0.05). Cognitive disturbance, retardation, and depression level were negatively correlated with creatinine (p < 0.05). Diurnal variation was negatively correlated with sodium ion (p < 0.01); hopelessness and depression level were positively correlated with chloride ion (p < 0.05); diurnal variation, retardation, and depression level were negatively correlated with anion gap (p < 0.05). Diurnal variation (p < 0.01) and retardation (p < 0.05) were negatively correlated with osmolality. Cognitive disturbance and depression level were positively correlated with estimated glomerular filtration rate (eGFR) (p < 0.05). In the MDD group, correlation analysis of thyroid function, renal function, and HAMA factor terms suggested that the total HAMA score and anxiety level were positively correlated with chloride ion (p < 0.05); psychic anxiety, total HAMA score, and anxiety level were negatively correlated with anion gap (p < 0.05). Furthermore, a low level of anion gap was an independent risk factor for depression and anxiety levels (p < 0.05).

Conclusion

Low thyroid function and reduced waste metabolized by the kidneys in patients with MDD suggest a low intake and low metabolism in depressed patients. In addition, subtle fluctuations in the anion gap in depressed patients were strongly correlated with the degree of depression and anxiety.

Estimated glomerular filtration rate from the renal hypothermia trial: clinical implications

OBJECTIVE

To assess if estimated glomerular filtration rate (eGFR) can replace measured GFR (mGFR) in partial nephrectomy (PN) trials, using data from a randomised clinical trial.

PATIENTS AND METHODS

We conducted a post hoc analysis of the renal hypothermia trial. Patients underwent mGFR with diethylenetriaminepentaacetic acid (DTPA) plasma clearance preoperatively and 1 year after PN. The eGFR was calculated using the 2009 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equations incorporating age and sex, with and without race: 2009 eGFRcr(ASR) and 2009 eGFRcr(AS), and the 2021 equation that only incorporates age and sex: 2021 eGFRcr(AS). Performance was evaluated by determining the median bias, precision (interquartile range [IQR] of median bias), and accuracy (percentage of eGFR within 30% of mGFR).

RESULTS

Overall, 183 patients were included. Pre- and postoperative median bias and precision were similar between the 2009 eGFRcr(ASR) (-0.2 mL/min/1.73 m2 , 95% confidence interval [CI] -2.2 to 1.7, IQR 18.8; and -2.9, 95% CI -5.1 to -1.5, IQR 15, respectively) and 2009 eGFRcr(AS) (-0.3 mL/min/1.73 m2 , 95% CI -2.4 to 1.5, IQR 18.8; and -3.0, 95% CI -5.7 to -1.7, IQR 15.0, respectively). Bias and precision were worse for the 2021 eGFRcr(AS) (-8.8 mL/min/1.73 m2 , 95% CI -10.9 to -6.3, IQR 24.7; and -12.0, 95% CI -15.8 to -8.9, IQR 23.5, respectively). Similarly, pre- and postoperative accuracy was >90% for the 2009 eGFRcr(ASR) and 2009 eGFRcr(AS) equations. Accuracy was 78.6% preoperatively and 66.5% postoperatively for 2021 eGFRcr(AS).

CONCLUSION

The 2009 eGFRcr(AS) can accurately estimate GFR in PN trials and could be used instead of mGFR to reduce cost and patient burden.

Organ function biomarker abnormalities, associated factors and disease outcome among hospitalized patients with COVID-19

Background: The aim of this study was to determine the magnitude of abnormal organ function tests and biomarkers in hospitalized patients with confirmed COVID-19 and to define the association among markers of organ failure, disease severity and its outcome in hospitalized COVID-19 patients in Ethiopia. Methods: A prospective cohort study was conducted among COVID-19 patients admitted to Millennium COVID-19 Treatment Center from December 2020 to June 2021. Results: The median age of the 440 study participants was 60.3 ± 1.3 years, and from these 71.3% of patients were male. Disease severity: p-value: 0.032; adjusted odds ratio (AOR) (95% CI): 4.4 (0.022-0.085); and the presence of any co-morbidity; p-value: 0.012; AOR (95% CI): 0.80 (0.47-0.83) was significantly associated with mortality. Aspartate transaminase, alanine transaminase and alkaline phosphatase parameter values of patients overall, were elevated - mainly among critical patients (56.9 ± 57.7, 58.5 ± 63 and 114.6 ± 60, respectively).

Does diffusion-weighted magnetic resonance imaging help in the detection of renal parenchymal disease and staging/prognostication in chronic kidney disease?

Purpose

Diffusion-weighted imaging (DWI) in renal diseases is an upcoming modality, and its utility as an additional marker is yet to be proven. This study was intended to find the relationship between apparent diffusion coefficient (ADC) values with renal function tests and stages of chronic kidney disease (CKD) to assess renal dysfunction, and to label a cut-off for normal renal function and dysfunction.

Material and methods

A prospective diagnostic study was conducted on 120 patients: 60 with deranged renal function tests (RFT) and 60 with normal RFT. DWI using a 1.5-Tesla MRI (at b-values of 0 and 500 s/mm²) was done. A region of interest of size 1-2 cm² was placed on renal parenchyma in the region of medulla, one each, over the superior, mid, and lower regions of each kidney separately. ADC values were recorded for renal parenchyma and compared.

Results

In patients with renal dysfunction ADC values were significantly lower than in patients with normal function (1.75 ± 0.25 vs. 2.28 ± 0.21 of right kidney and 1.79 ± 0.17 vs. 2.29 ± 0.21 of left kidney [×10⁻³ mm²/s]; p = 0.001). ADC values of different stages of CKD showed a decreasing trend with increasing stage.

Conclusions

ADC values taken at all poles to get focal involvement of the kidney can be used to measure each kidney separately, and values can be individually correlated with the elevated renal parameters. The cut-off value of the mean ADC for individual kidneys was > 2.28 (×10⁻³ mm²/s) in normal renal function and < 2.00 (×10⁻³ mm²/s) in renal dysfunction.

Frequency of Hepatorenal Syndrome Among Patients With Cirrhosis and Outcome After Treatment

Introduction

Hepatorenal syndrome is the third most common cause of admissions among patients with liver cirrhosis and has a high mortality rate. It is a progressive deterioration of renal function in a patient with acute or chronic liver failure. The only definite curative treatment of choice for hepatorenal syndrome is liver transplantation. This study aimed to determine the frequency of hepatorenal syndrome among patients with liver cirrhosis and to determine its outcome after treatment.

Patients and Methods

This case series prospective study was conducted at the Department of Medicine, CMH Lahore Medical College and Institute of Dentistry, Pakistan, from January 2019 to December 2019. The study included 136 patients of cirrhosis who were identified and worked up for hepatorenal syndrome. The patients with liver cirrhosis diagnosed as having hepatorenal syndrome were given treatment comprising injection terlipressin 2 mg four times a day and injection Haemaccel twice a day for two weeks, and after that the outcome was measured with a follow-up of six weeks.

Results

A total of 136 patients of cirrhosis were included in the study. Of the patients, 14 (10.3%) were diagnosed as suffering from hepatorenal syndrome. These diagnosed cases were given treatment for two weeks. Three (21.4%) of the patients having hepatorenal syndrome did not show any response, two (14.3%) patients recovered partially, four (28.6%) patients recovered fully, and four (28.6%) expired within one month of the treatment. One (7.14%) patient was referred during the treatment for liver transplant.

Conclusions

Hepatorenal syndrome is a common complication of cirrhosis. The treatment of systemic vasoconstrictors for hepatorenal syndrome proved to be effective in our study and should be the first priority for treating hepatorenal syndrome especially in places like Pakistan where liver transplantation is not that easily available.

Correlation of Thyroid Hormone Profile with Biochemical Markers of Renal Function in Patients with Undialyzed Chronic Kidney Disease

OBJECTIVE

The present study was conducted to evaluate the correlation of renal functions with thyroid hormone levels in patients with undialyzed chronic kidney disease (CKD). Literature shows significant alteration in thyroid hormone function tests in CKD patients who are receiving long-standing dialysis treatment. However, not much is described in those receiving conservative management without dialysis. Although CKD is associated with an increased prevalence of primary hypothyroidism, various studies on thyroid hormone status in uremic patients have reported conflicting results.

METHODOLOGY

Thyroid hormone levels and biochemical markers of renal function were estimated in 30 undialyzed CKD patients and similar number of age- and sex-matched healthy controls, followed by statistical analysis and correlation.

RESULTS

Free triiodothyronine (FT3) and free thyroxine (FT4) were found to be significantly reduced (P < 0.001 for each) in undialyzed CKD patients whereas thyroid-stimulating hormone (TSH) levels showed statistically insignificant alteration in both groups. We also observed that urea and creatinine were negatively correlated whereas creatinine clearance was positively correlated with both FT3 and FT4 having high statistical (two tailed) significance with P < 0.001. Nonsignificant correlation was seen between blood urea and TSH (r = 0.236, P = 0.069), creatinine clearance, and TSH (r = 0.206, P = 0.114 Pearson's correlation coefficient). There is just significant positive correlation between the serum creatinine values and TSH (r = 0.248, P = 0.049).

CONCLUSIONS

Thyroid hormones were significantly decreased in undialyzed CKD patients as compared to healthy controls.

Assessment of renal function and electrolytes in patients with thyroid dysfunction in Addis Ababa, Ethiopia: a cross sectional study

Introduction

Studies demonstrated that abnormal thyroid functions may result in decreased or increased kidney size, kidney weight, and affect renal functions. In this regard, studies on the association of abnormal thyroid functions and renal function tests are scarcely found in Ethiopia.

Objective

To assess renal function and electrolytes in patients with thyroid dysfunction, in Addis Ababa, Ethiopia.

Methods

Cross sectional study was conducted from March 21/2015-May 27/2015 at Arsho Advanced Medical Laboratory. During the study period, 71 patients with thyroid dysfunction were eligible, and socio demographic data collected by structured questionnaire. Then blood sample was collected for thyroid function tests, renal function and blood electrolyte analysis. The collected data was analyzed by SPSS version 20. ANOVA and binary logistic regression were employed to evaluate the mean deference and associations of thyroid hormone with renal function and electrolyte balances.

Results

Among the renal function tests, serum uric acid, and creatinine mean values were significantly decreased in hyperthyroid patients; whereas, eGFR mean value was significantly increased in hyperthyroid study patients (P<0.05). Meanwhile, from the electrolyte measurements made, only the mean serum sodium value was significantly increased in hyperthyroid study participants. Binary logistic regression analysis on the association of thyroid dysfunction with electrolyte balance and renal function tests indicated that serum sodium, creatinine, eGFR values and hyperthyroidism have a statistical significant association at AOR 95% CI of 0.141(0.033-0.593, P=0.008); 16.236(3.481-75.739, P=0.001), and 13.797(3.261-58.67, P=0.001) respectively.

Conclusion

The current study reveals, thyroid abnormalities may lead to renal function alterations and also may disturb electrolyte balance. Knowledge of this significant association has worthwhile value for clinicians, to manage their patients' optimally.

Risk factors for developing oral 5-aminolevulinic acid-induced side effects in patients undergoing fluorescence guided resection

Oral 5 aminolevulinic acid (5-ALA) is used to assist surgical resection of malignant tumours in the brain and other locations. Hypotension and alteration of liver functions have been reported as potential adverse effects. This study was designed to assess the incidence and contributing factors that cause 5-ALA induced side effects in a cohort of 90 patients. Hypotension occurred in 11% of patients irrespective of 5-ALA dose. The only contributing factor was the presence of cardiovascular disease and antihypertensive drug therapy with an odd ratio of 17.7. Liver function were disturbed in 2% in patients who received 20mg or less/kg body weight compared to 4% in those who received a dose of >20mg/kg 5-ALA. The liver dysfunction was minor and was not clinically significant. We concluded that 5-ALA induced side effects were minimal and hypotension more likely to occur in patients receiving antihypertensive drug therapy.