Endocrine disorders in chronic kidney disease

Abstract

The increasing prevalence of chronic kidney disease gives rise to many diagnostic challenges in the daily care of this group of patients. This paper presents the most clinically significant endocrine disorders accompanying chronic kidney disease, their aetiology, diagnosis, clinical picture and treatment. Endocrine disorders may occur in patients with chronic kidney disease with greater or equal frequency as in the general population. The most important endocrine disorders include: low triiodothyronine syndrome, subclinical and overt hypothyroidism, hypercortisolaemia, hyperprolactinaemia, increased levels of growth hormone, hyperinsulinaemia, insulin resistance and hypogonadism. Hyperthyroidism and autoimmune thyroid disease occur with the same frequency in patients with chronic kidney disease as in the general population. Chronic kidney disease also affects commonly used hormone determinations. The choice of the therapeutic method in patients with chronic kidney disease is not without importance for endocrine disorders. Among patients undergoing dialysis therapy, a temporary increase in free thyroid hormones, a decrease in the severity of hypercortisolaemia and a decrease in hormone levels were observed. Dialysis therapy does not normalise prolactin levels, unlike kidney transplantation, where an improvement in glomerular filtration rate results in the normalisation of serum prolactin. The therapeutic management of some of the presented endocrine disorders is not based on a causal effect, but mainly on controlling their complications (e.g. secondary to hypercortisolaemia – hypertension, diabetes, osteopenia or abdominal obesity). In the remaining cases, hormone replacement therapy was associated with a beneficial effect for the patient: testosterone replacement in obese men with hypogonadism led to a decrease in body mass index, and cyclical transdermal hormone replacement therapy in women with oestrogen deficiency secondary to renal failure inhibited bone demineralisation and thus prevented early osteoporosis.

Autoimmune disorders associated with type 1 diabetes: clinical overview and principles of management

“…A study by Gimenez-Perez et al found that isolated AITD was associated with a lower incidence of kidney disease, while the co-occurrence of other AID elevated the incidence of ischaemic heart disease (8) . Both hyperthyroidism and hypothyroidism in several complex processes can lead to pre-renal and renal kidney damage by affecting renal blood flow, glomerular filtration rate (GFR), and renal tubular function (23) . Prinz et al point to an increased risk of diabetic nephropathy in patients with T1DM and HT, although levothyroxine replacement therapy makes it possible to reverse this pathomechanism and demonstrates a nephroprotective effect (18) .…”