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Kidney Week

Abstract: PO1912

Graves Disease and Nephrotic Syndrome

Session Information

Category: Trainee Case Report

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Mahmood, Sajid, Loyola University Health System, Maywood, Illinois, United States
  • Mazhari, Alaleh, Loyola University Health System, Maywood, Illinois, United States
  • Emanuele, Nicholas, Loyola University Health System, Maywood, Illinois, United States
  • Leehey, David J., Loyola University Health System, Maywood, Illinois, United States
Introduction

Disorders of the thyroid and kidney may co-exist. Isolated case reports of Graves’ disease associated with various glomerular diseases, including membranous nephropathy, membranoproliferative GN, fibrillary GN, and minimal change disease have been published. A patient with membranous nephropathy and Graves’ disease who had improvement but not resolution of proteinuria after treatment with radioactive iodine has been described (Sasaki et al. CEN Case Rep. 2014; 3(1): 90-93). We report a case of nephrotic syndrome associated with Graves’ disease which completely resolved after treatment of the thyroid disease with radioiodine.

Case Description

A 33-year-old healthy female was seen for evaluation of proteinuria discovered during a routine life insurance evaluation. BP was normal, and she had trace-1+ lower extremity edema. Urinalysis showed 3+ protein, 1 red blood cell and 1 white blood cell per high power field. Urinary albumin/creatinine ratio was 4010 mg/g. Serum albumin was 2.7 g/dL. Renal function was normal. Tests for hepatitis B and C, HIV, RPR, ANA, C3, C4, cryoglobulins, immunofixation, and free light chains were normal. Renal biopsy was planned but the patient missed the biopsy date. Subsequently she returned to clinic complaining of neck swelling. Exam revealed tachycardia, palpable goiter, 1+ pedal edema, no tremor. She reported heat intolerance, occasional diarrhea, insomnia, diaphoresis, and weight loss for the past month. A thyroid panel showed TSH <0.01 UU/mL (0.40-4.60 UU/mL), free T3 >2000 pg/dL (230-420), and free T4 10.6 ng/dL (0.8-1.7). TSH receptor and thyroid peroxidase antibodies were present. The patient was treated with methimazole and tapering steroids. She refused thyroid surgery and ultimately underwent two sessions of radioactive iodine treatment. After this treatment, nephrotic syndrome went into complete remission (Figure).

Discussion

Although relatively uncommon, Graves’ disease needs to be considered as a reversible cause of nephrotic syndrome.