A 36-YEAR-OLD WOMAN WITH FOCAL SEGMENTAL GLOMERULOSCLEROSIS AND HYPOTHYROIDISM

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A 36-YEAR-OLD WOMAN WITH FOCAL SEGMENTAL GLOMERULOSCLEROSIS AND HYPOTHYROIDISM

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Co-author 1

HENDRIK WAHYUDI henwahyudi3@gmail.com DR. MOEWARDI HOSPITAL - UNIVERSITAS NEGERI SURAKARTA NEPHROLOGY AND HYPERTENSION SURAKARTA Indonesia *

Co-author 2

ARYO SUSENO aryosuseno23@gmail.com DR. MOEWARDI HOSPITAL - UNIVERSITAS NEGERI SURAKARTA NEPHROLOGY AND HYPERTENSION SURAKARTA Indonesia -

Co-author 3

RATIH TRI KUSUMA DEWI ratihsolo@staff.uns.ac.id DR. MOEWARDI HOSPITAL - UNIVERSITAS NEGERI SURAKARTA NEPHROLOGY AND HYPERTENSION SURAKARTA Indonesia -

Co-author 4

AGUNG SUSANTO agungsus@staff.uns.ac.id DR. MOEWARDI HOSPITAL - UNIVERSITAS NEGERI SURAKARTA NEPHROLOGY AND HYPERTENSION SURAKARTA Haiti -

Co-author 5

BAMBANG PURWANTO bambang_p48@staff.uns.ac.id DR. MOEWARDI HOSPITAL - UNIVERSITAS NEGERI SURAKARTA NEPHROLOGY AND HYPERTENSION SURAKARTA Indonesia -

Co-author 6

SANTY AYU PUSPITA PERDHANA santyayupp@gmail.com DR. MOEWARDI HOSPITAL - UNIVERSITAS NEGERI SURAKARTA NEPHROLOGY AND HYPERTENSION SURAKARTA Indonesia -

Co-author 7

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Co-author 12

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Co-author 15

Introduction

Focal Segmental Glomerulosclerosis is one of the causes of nephrotic syndrome which can develop into chronic kidney disease. Focal Segmental Glomerulosclerosis can cause hypothyroidism due to urinary loss of hormon binding proteins. In some study , 80 % of patient at the low T4 group had FSGS and FSGS was the second most common kidney disease associated with thyroiditis

Methods

Laboratory results at the time of inpatient admission

A 36 year old woman referred from a regional hospital with a diagnosis of nephrotic syndrome who had received methylprednisolone therapy. The patient underwent a kidney biopsy and obtained FSGS results. On physical examination, signs of hypothyroidism were found with a Billewicz score of 25 and laboratory examination showed high TSH levels and low FT4. The patient was given therapy for FSGS and hypothyroidism.

Based on clinical and biochemical parameters suggestive of nephrotic syndrome (NS), an ultrasound-guided renal biopsy was performed, which revealed FSGS involving glomeruli showing segmental sclerosis at the tubular pole.

Results

Focal Segmental Glomerulosclerosis can cause nephrotic syndrome in 40% of adult patients and 20% of children, which is the main cause of ESRD in 50% of affected patients. Hypothyroidism can occur due to loss of thyroid hormone binding globulin and thyroxine through urine in patients with nephrotic syndrome. Patients with FSGS and hypothyroidism have higher urinary protein expression than patients with normal thyroid function, which can worsen the condition of nephrotic syndrome. This patient was given combination therapy of methylprednisolone, ramipril, cyclosporine and levothyroxine

Conclusion

This case is about a young female patient with FSGS and hypothyroidism. Several studies have shown an association between fsgs and hypothyroidism. It is important to monitor thyroid function levels and urinary protein expression to assess the progress of the condition of FSGS patients with hypothyroidism

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