الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Approximately, 10% of children with nephrotic syndrome (NS) are suffering from steroid resistant nephrotic syndrome (SRNS). Prolonged proteinuria is the main feature of SRNS that leads to loss of thyroxine binding globulin and albumin resulting in low level of thyroid hormones. It also may lead to thyroid gland failure to compensate for the continuous loss of hormones in urine.
The aim of the work of the current study was assessment of thyroid function (TSH, total T4, FT4, total T3, FT3 ) in patients with SRNS and correlate the levels of thyroid hormones with the clinical and laboratory findings of the patients and determine the frequency of subclinical and overt hypothyroidism in children with SRNS.
A total of 50 cases of SRNS, 50 cases of SSNS and 50 controls were recruited for this comparative cross sectional study. Patients’ files were reviewed and data were analyzed. Weight, height and BMI were measured and their standard deviations were calculated. The following laboratory tests had been done: (BUN, creatinine, albumin, cholesterol, triglycerides, urinalysis, urinary protein /creatinine ratio, C3, C4, HCV Ab, HBs Ag, tuberculin test). Besides, thyroid function, including thyroid stimulating hormone (TSH) level, free and total triiodothyronine (T3) level and free and total thyroxine (T4) level, were measured.
In the present study, the majority of cases (68%) were males. The median cumulative dose of corticosteroids (mg/kg/year) in children with SRNS was significantly higher compared to children with SSNS. Regarding serum albumin, 60% SRNS patients had hypoalbuminemia. 14% of SSNS patients had hypoalbuminemia. Proteinuria was found in 47 children (94%) of SRNS group compared to 15 children (30%) of SSNS children and 5 children (10%) of control children.
The mean TSH level was significantly more in children with SRNS compared to children with SSNS and children in control group. It was found that 54% (n= 27) of SRNS patients had high level of TSH compared to 12% (n= 6) of SSNS children and no cases in controls. Thyroid anti thyroglobulin Ab and anti-peroxidase Ab were normal in SRNS and SSNS patients excluding autoimmunity. There were no laboratory findings of overt hypothyroidism between the three groups. Besides, there were no symptoms of hypothyroidism in any of the children in the study. The prevalence of subclinical hypothyroidism was much higher in SRNS (54%) group than in SSNS (12%) or control (no cases) groups.
The median of systolic blood pressure percentile was significantly higher in NS children with high TSH compared to NS children with normal TSH. This finding may reflect that subclinical hypothyroidism might be a risk factor for hypertension.
In NS children with high TSH, there was a higher percentage of hypoalbuminemia (93.9%), proteinuria (100%), hypercholesterolemia (57.7%) and hypertriglyceridemia (60.6%) compared to NS children with normal TSH.