Simultaneous Occurrence of Minimal Change Glomerular Disease, Sarcoidosis and Hashimoto’s Thyroiditis

Abstract

We herein report a very rare case of a patient suffering from simultaneous occurrence of three immune disorders, i.e. Hashimoto's thyroiditis, sarcoidosis and minimal change glomerular disease. A 66-year-old man was admitted to our hospital for evaluation of nephrotic syndrome. Six months before admission, he was pointed out as having positive proteinuria, hypoalbuminemia and associated pretibial pitting edema. Initial laboratory data showed high gammaglobulinemia, high titers of both antimicrosomal and antithyroglobulin antibodies with normal thyroid function. Chest X-ray and CT scan revealed bilateral hilar lymphadenopathy with interstitial shadow. Ga-citrate scan disclosed positive accumulation in the thyroid glands, the mediastinum, the lungs and the kidneys. The diagnosis of minimal change nephritic syndrome and pulmonary sarcoidosis was made, based on the findings of transbronchial lung biopsy and kidney biopsy. After one and a half months of admission, thyroid function had gradually deteriorated. The histological findings of the thyroid were consistent with the features of Hashimoto's thyroiditis. Treatment with prednisolone and cyclophosphamide resulted in a decrease in urinary protein excretion, reduction in the size of mediastinal lymphadenopathy and disappearance of positive findings of Ga-citrate scan in the thyroid glands and the kidneys. Simultaneous occurrence of minimal change-glomerular disease, sarcoidosis and Hashimoto's thyroiditis in our case suggests that similar immunological abnormalities may be involved in the pathogenesis of the diseases.

A case of autoimmune thyroiditis and membranoproliferative glomerulonephritis

“…The most common glomerular lesion among these reports based on renal biopsy findings is membranous glomerulonephritis. Minimal-change disease is another renal lesion described in association with autoimmune thyroiditis [6,15].…”

“…Renal involvement in autoimmune thyroiditis is not uncommon, usually manifesting as proteinuria, seen in 11-30% of cases [3][4][5]. Other observed renal manifestations of thyroid disease include distal renal tubular acidosis and rapidly progressive glomerulonephritis, whereas several types of pathology have been demonstrated, including membranous nephropathy, immunoglobulin (Ig)A nephropathy, and minimalchange disease [6][7][8][9][10][11][12][13][14][15]. Only one published case of membranoproliferative glomerulonephritis (MPGN) (interchangeably termed mesangiocapillary glomerulonephritis) associated with isolated thyroid disease was noted in preparing this report [12].…”

Thyroid dysfunction and kidney disease

“…The more frequent form is membranous glomerulopathy associated with nephrotic syndrome (NS) (50,52,(55)(56)(57)59). Thyroid dysfunction has been reported to be associated with IgA glomerulonephritis (49,51,60), mesangiocapillary or membranoproliferative glomerulonephritis (47, 48,61), and minimal change glomerulonephritis (58,59,62,63).…”

Abnormalities of thyroid function tests in adult patients with nephrotic syndrome

“…Coexistence of autoimmune hypothyroidism has been described previously with various histological types of nephrotic syndrome, especially with membranous nephropathy. [14][15][16][17][18] In our study, four of 15 patients with membranous nephropathy had elevated anti-TPO antibodies.…”