Adiponectin, leptin and thyroid hormones in patients with chronic renal failure and on renal replacement therapy: are they related?

BACKGROUND: Renal function affects thyroid function and adipocytokines in many ways. We aimed to assess the adipocytokines adiponectin and leptin in relation to thyroid function in patients with chronic renal failure treated conservatively, in haemodialysed patients and in kidney allograft recipients. METHODS: The study was performed on 33 patients with chronic renal failure, 64 haemodialysed patients, 54 kidney allograft recipients and 38 healthy volunteers. Thyroid volume was estimated sonographically, thyroid hormones were determined by Micropartide Enzyme Immunoassay (MEIA), and serum adiponectin and leptin were assessed by radioimmunoassay. RESULTS: Serum thyroid-stimulating hormone (TSH), free T4 and free T3 were within the normal range. Adiponectin correlated significantly with free T3, haematocrit, haemoglobin, platelet count, body mass index (BMI) and urea in kidney allograft recipients. In haemodialysed patients, adiponectin correlated with free T4 and TSH, whereas leptin correlated with free T3. Multiple regression analysis showed that adiponectin was independently related only to the serum concentration of free T3 and urea in kidney transplant recipients and to free T4 and adequacy of dialysis in haemodialysed patients. In univariate analysis in patients with chronic renal failure, adiponectin correlated with free T3 and platelet count, and in healthy volunteers adiponectin correlated only with free T3 and triglycerides, and leptin correlated with BMI. CONCLUSIONS: We described novel relationships between adiponectin and thyroid hormones in patients with kidney diseases. However, possible pre-existing thyroid dysfunction prior to transplantation (during dialysis therapy) and immunosuppression after transplantation make all these findings relatively complex. Therefore, the relationships between adiponectin and the thyroid axis in patients with chronic renal failure, in haemodialysed subjects or in kidney transplant recipients merit additional studies.     

Thyroid disorders in hemodialysis patients in an iodine-deficient community

There are various changes in the thyroid gland and its function in chronic renal failure (CRF). These changes include lower levels of circulating thyroid hormone, altered peripheral hormone metabolism, decreased binding to carrier proteins, possible reduction in tissue hormone content, and increased iodine storage in the thyroid gland. The decrease of excretion of urinary iodine in CRF increases serum inorganic iodine level and iodine content of the thyroid, which consequently enlarges the gland. This study is designed to investigate the prevalence of goiter and thyroid dysfunction in patients with end-stage renal disease (ESRD) on hemodialysis (HD) in an iodine-deficient community. Eighty-seven (40 females and 47 males) HD patients and 169 (79 females and 90 males) healthy individuals as controls are included. Sex ratios for the patient and control groups are 0.85 and 0.88, respectively. Mean ages for the patient and control groups are 42.94 +/- 11.88 and 40.20 +/- 10.72 years, respectively. Examination of the thyroid gland using ultrasonography along with simultaneous measurement of blood levels of free-T4 (FT4), free-T3 (FT3), and thyrotropin (TSH) are made for every individual. The presence of goiter demonstrable by ultrasonography is found in 32.2% of the uremic patients and in 23.5% of the controls and its prevalence increases with age (P = 0.01). In 32 (36.8%) of the patients and 29 (17.1%) of the controls at least one thyroid nodule is found in ultrasonography. Between patients with or without a nodular goiter the authors could not observe any difference for duration of dialysis and serum levels of TSH, FT4, FT3, calcium, and albumin. In ESRD patients the prevalence of nodular goiter is higher for females (47.5% vs. 27.7%, P = 0.045) and increases with age (P = 0.04). Though incidence of hyperthyroidism is found to be similar for the two groups (1.14% in ESRD patients vs. 1.10% in controls), hypothyroidism is observed in 3.4% of ESRD patients but only 0.6% of controls. This high incidence of hypothyroidism and nodular goiter in ESRD patients shows that screening for thyroid dysfunction and goiter, using appropriate laboratory tests and ultrasonography, should be considered in evaluation of every ESRD patient.     

Free thyroxine, free triiodothyronine and thyroid-stimulating hormone before and after hemodialysis in Saudi patients with end-stage renal disease: is there any difference?

Patients on regular hemodialysis (HD) suffer from a chronic illness that is believed not to involve the thyroid gland. However, they may have low levels of serum thyroxine (T4) and tri-iodothyronine (T3). It was found earlier that serum total T3 and free T4 concentrations were significantly higher immediately after a HD session than before. In this single-center prospective study, we evaluated the difference between free T3 (FT3), free T4 (FT4) and thyroid-stimulating hormone (TSH) levels before and immediately after HD sessions in 40 Saudi patients with end-stage renal disease undergoing regular HD at the Prince Salman Center for Kidney Disease, Riyadh, Saudi Arabia. The study involved 23 female and 17 male patients with a mean age of 49.65 ± 16.20 years. None of the study patients had any known thyroid disease. We measured the thyroid hormones monthly for three successive months using the electrochemiluminescence technique both before and after HD sessions. At the end of our study, we found a statistically significant difference between pre-HD and post-HD levels for FT3; in the first month, it was 4.47 ± 1.01 versus 4.86 ± 1.03 pmol/L, (P = 0.004); in the second month, it was 4.48 ± 1.37 versus 4.83 ± 1.64 pmol/L, (P = 0.008); and in the third month, it was 3.84 ± 0.88 versus 4.04 ± 0.84 pmol/L, (P = 0.003). The FT4 in the first month was 15.42 ± 2.75 pmol/L versus 17.20 ± 2.85 pmol/L, P = 0.000, in the second month it was 14.86 ± 2.66 versus 16.74 ± 3.27 pmol/L, P = 0.000 and in the third month it was 14.86 ± 3.93 versus 16.70 ± 4.00 pmol/L, P = 0.000, respectively. However, the pre- and post-HD levels of TSH did not show any statistically significant difference; in the first month it was 3.17 ± 1.47 versus 3.32 ± 1.39 pmol/L, P = 0.254, in the second month it was 2.57 ± 1.36 versus 2.49 ± 1.29 pmol/L, P = 0.299 and in the third month it was 2.36 ± 1.17 versus 2.44 ± 1.22 pmol/L, P = 0.238, respectively. Thus, there was a statistically significant increase in the post-HD levels of FT3 and FT4 although the TSH levels did not show any significant change. Our study suggests that measurement of TSH alone might be more reliable in the assessment of thyroid function in patients on regular HD than FT3 and FT4.     

Plasma free thyroxine concentrations in patients receiving levothyroxine for thyroid suppression

The usual recommendation is to follow total triiodothyronine (T3) concentration during levothyroxine (L-thyroxine) therapy because 65% of clinically euthyroid patients receiving L-thyroxine have normal T3 but elevated total thyroxine (T4) levels. Because free thyroxine (FT4) is the metabolically active form of T4, our study was designed to determine whether FT4 by analog radioimmunoassay method is normal or increased in euthyroid patients receiving L-thyroxine. Twenty-seven clinically euthyroid patients, 5 males and 22 females, receiving L-thyroxine for thyroid suppression, were studied in a prospective protocol. Twenty-one euthyroid patients not receiving L-thyroxine served as controls. Samples were analyzed for T4, T3, T3 (RU), TSH, and FT4 by three analog methods. Mean FT4 levels were greater than control for all three assays. The percentage of patients with FT4 in the hyperthyroid range was 63% for assay I, 41% for assay II, and 52% for assay III. When patients were grouped by dose of L-thyroxine, FT4 levels were not significantly increased. Sixty-two percent of patients receiving L-thyroxine had T4 levels in the hyperthyroid range. T3 concentrations were not significantly greater in the L-thyroxine group when compared with control. In the L-thyroxine group, thyrotropin was significantly less than in the control group. FT4 concentration by analog method is in the hyperthyroid range in as many as 63% of clinically euthyroid patients receiving L-thyroxine. The use of FT4 to assess thyroid status may cause inappropriate adjustment of L-thyroxine dose. T3 level continues to parallel closely the physician's clinical impression and best represents peripheral metabolic status.     

Thyroid Function in Renal Failure

Renal failure is often associated with abnormal thyroid function tests which may make the diagnosis of thyroid dysfunction difficult (Table 1). As many as one-half of patients with renal failure have low thyroid function indices. Although clinically the patients are usually euthroid, there is evidence from animal and human studies that there may be some degree of tissue hypothyroidism in patients with renal failure. Whether this tissue hypothyroidism reflects an adaptive reaction to the uremic state is not clear.
Contributory factors to the alteration in thyroid function tests in renal failure are multiple and include poor nutritional status, medications, metabolic disturbances, hemodialysis, and associated nonthyroidal illnesses. All of these are known to affect thyroid function tests, and it is difficult to dissociate their influence from that of the uremic state. In most instances, the changes in thyroid function tests are similar to those encountered during nonthyroidal illness and include low levels of T₃, with normal or low levels of T₄, a variable free thyroxine index, and a normal, suppressed, or elevated level of TSH. One feature distinguishing renal failure from other non-thyroidal illnesses is the often normal rT₃ and elevated free rT₃ levels seen in acute and chronic renal failure. This appears to be related to the increased binding of rT₃ to intracellular binding proteins.
During hemodialysis, the free T₄ level is elevated transiently but may be abnormally elevated or low in the presence of a coexistent nonthyroidal illness. TSH is normal or only slightly elevated.
Transplant patients, who often receive high doses of steroids, may have abnormal thyroid function tests, in particular hypothyroxinemia and suppressed levels of basal TSH.     

Spontaneous pituitary-thyroid function after surgical treatment of nontoxic goitre. A controlled long-term study

The free thyroxine index (FT4I), triiodothyronine (T3) and thyroid stimulating hormone (TSH) in serum and the peak serum TSH (TRH test) were measured in 18 patients with nontoxic uninodular goitre and 32 patients with nontoxic multinodular goitre before and 3, 6, 12, 24 and 36 months after goitre resection. Thyroid hormone therapy was not given postoperatively. Resection of non-toxic goitre provoked a transient rise in TSH baseline level, with peak about one year after surgery. Three years after the resection the TSH baseline had returned to the preoperative level. The TSH changes were significantly more pronounced in the multinodular goitrous group, in which resection was bilateral, than in the uninodular goitrous group. The changes in serum FT4I and serum T3 were of moderate degree and most pronounced in the multinodular group. During long-term observation, serum FT4I increased slightly but significantly in both groups, but serum T3 showed significant reduction, albeit within reference range. The results of the study suggest that thyroid hormone therapy as a routine procedure after simple goitre resection lacks a tenable rational basis.     

甲状腺素片补充治疗对慢性肾脏疾病患者甲状腺激素水平的影响研究

目的 探讨小剂量甲状腺素补充治疗对慢性肾脏疾病患者的甲状腺激素水平、营养不良及左心功能的影响.方法 湖南省人民医院2013年2月至2015年2月间收治的慢性肾脏疾病患者210例,A组为eGFR＜ 15mL ·(min·1.73m2)-1的患者(n=70),B组为15＜ eGFR＜30mL·(min·1.73m2)-1的患者(n=70),C组为30 ＜eGFR ＜60mL·(min·1.73m2)-1的未透析患者(n=70).选择同期本院体检的正常人群为正常对照组(D组,n =70).收集4组患者血液、生化临床资料,检测游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、游离甲状腺素(freethyroxine,FT4)、促甲状腺激素(thyroid stimulating hormone,TSH)、C反应蛋白(C reactive protein,CRP)、左心室射血分数(left ventricular ejection fraction,LVEF)及左心室质量指数(Left ventricular mass index,LVMI),并计算主观综合性营养评估法(subjective global assessment of nutritional act,SGA)等指标.每组根据甲状腺激素水平分为正常组Ⅰ、异常组Ⅱ,观察各组间各指标差异,再给予异常组小剂量甲状腺激素干预后观察各项指标改变.结果 A、B、C组FT3均显著低于D组(P＜0.05),低T3综合征的发生率随eGFR下降而升高;正常组Ⅰ与异常组Ⅱ相比,ALB、CRP、SGA、LVEF、LVMI比较有显著差异(P＜0.05);异常组的FT3与eGFR、SGA、ALB、LVEF呈显著正相关(r=0.912,P＜0.001;r =0.721,P＜0.001;r =0.810,P＜0.001;r=0.903,P＜0.001);FT3与CRP、LVMI呈负相关(r=-0.981,P＜0.001;r=-0.442,P＜0.001);异常亚组给予小剂量甲状腺素治疗后FT3及LVEF较治疗前明显改善(P＜0.05),治疗后eGFR水平只有C2组患者有提高(P＜0.05).结论 甲状腺素水平下降与肾功能严重程度相关,以血清FT3水平降低为主;低水平FT3与营养、左心功能有显著相关性;予以小剂量的甲状腺激素治疗后的低T3及亚临床甲减者的左心收缩功能有提高,中度肾功能损伤的患者eGFR有提高.     

Is there any relation between thyroid gland function and kidney transplant function?

INTRODUCTION: Patients with chronic renal failure exhibit abnormalities of thyroid function. Reports regarding thyroid function in kidney transplant recipients (TX) are rare, particularly those individuals on long-term immunosuppression. The aim of this study was to investigate correlations between FT3, FT4, TSH concentrations, thyroid volume, and graft function. MATERIAL AND METHODS: The study enrolled 46 kidney allograft recipients (aged 27-67 years,) engrafted between years 1994 and 2000 and clinically stable. The mean time after TX was 45.3 +/- 37.4 months. Transplanted patients received prednisone, cyclosporine, and azathioprine. The control group included 22 patients with normal renal function. In addition to serum creatinine, TSH, FT3, and FT4 concentrations, thyroid examinations were performed with a 7.5-MHz linear probe to calculated the thyroid volume. RESULTS: Thyroid volume in TX patients was 25.3 +/- 13.3 mL. A positive correlation existed between thyroid volume and serum creatinine (P <.05), and a negative one between thyroid volume and TSH (P <.05). No correlation was observed between TSH, FT4, and serum creatinine. The time after TX was negatively related to TSH (P <.05). A negative correlation existed also between FT3 and creatinine in TX patients (P <.05). In the control group the concentrations of TSH and FT3 were within normal ranges. CONCLUSION: The FT3 concentration correlates with function of the renal graft. In TX patients the supplementary thyroid hormone therapy should be considered.     

Diagnosis of hypothyroidism in patients with end-stage renal disease

Hypothyroidism may occur more commonly in patients with end-stage renal disease (ESRD) than in the general population. The signs and symptoms of both hypothyroidism and uremia may be similar. To evaluate the usefulness of clinical and routine laboratory findings in the diagnosis of hypothyroidism in patients with ESRD, we compared 6 patients with documented primary hypothyroidism who had serum thyrotrophin (TSH) levels above 20 microU/ml with 12 euthyroid patients. The euthyroid patients were divided into two groups. The first was matched with the hypothyroid patients for age, renal disease and duration of dialysis, while the second group was matched for serum total thyroxine and free T4 index values. Serum TSH levels were normal (less than 10 microU/ml) in both of these latter groups. There were no significant differences in the clinical manifestations among the three groups of patients, except for hoarseness of voice which was significantly more common in the hypothyroid uremic patients (p = 0.03). No significant differences were noted on electrocardiogram, physical examination, chest x-ray or echocardiography. Routine laboratory values were not different. Therapy of the uremic hypothyroid patients with L-thyroxine was associated with improvement or resolution of many of the symptoms and signs of hypothyroidism that otherwise would have been attributed to the uremic state. Our results indicate that the diagnosis of hypothyroidism in uremic patients cannot be made by clinical or routine laboratory values and rests on the presence of an overtly elevated serum TSH concentration.(ABSTRACT TRUNCATED AT 250 WORDS)     

Thyroid hormone transport is disturbed in erythrocytes from patients with chronic renal failure on hemodialysis

AIMS: To now, there are no studies reporting whether thyroid hormones (THs) transport play a role in thyroid hormone dysfunction observed in chronic renal failure (CRF). Therefore, the aim of this study was to investigate the transport of THs in erythrocytes from patients with CRF on hemodialysis (HD). METHODS: [125I]-L-triiodothyronine ([125I]T3) and [125I]-L-thyroxine ([125I]T4) erythrocytes uptake was measured at 1 min and 5 min. To study L-triiodothyronine (LT3) and L-thyroxine (LT4) efflux from erythrocytes, we preloaded the cells during 180 min with [125I]T3 or [125I]T4 and measured their [125I]T3 or [125I]T4 efflux during 60 min. RESULTS: [125I]T3 uptake in erythrocytes from uremic patients pre-HD was higher than control subjects by 50% at 1 min and by 55% at 5 min. However, [125I]T4 uptake in erythrocytes from uremic patients was significantly lower at 1min (88%) and at 5 min (63%). LT3 efflux rate was lower and LT4 efflux was significantly higher than in control subjects. After 60-min of efflux, LT3 remained in erythrocytes was 80% higher and LT4 was 57% lower than in normal individuals. Neither [125I]T3 and [125I]T4 uptake, nor efflux rates were changed by hemodialysis. CONCLUSION: Despite the fact that uremic patients on hemodialysis show low serum levels of LT3, changes in LT3 influx and efflux could act as a compensatory mechanism that neutralize thyroid hormone dysfunction in order to maintain the euthyroid state.     

Decreased bilirubin-binding capacity in uremic serum caused by an accumulation of furan dicarboxylic acid

In chronic renal failure, substances that are effectively excreted in healthy subjects accumulate in serum. These substances, uremic toxins, include a variety of organic acids. It has been reported that a decrease in the bilirubin (BR) binding capacity occurs in the serum of renal failure patients. 3-Carboxy-4-methyl-5-propyl-2-furanpropanoic acid (CMPF) has a high affinity for human serum albumin (HSA) and is a potent inhibitor of the serum protein binding of many drugs. We recently reported that CMPF and BR share the binding site for dicarboxylate molecules on the HSA molecule [Pharm Res 1999;16:916-923]. In this study, in order to confirm whether CMPF is involved in the decrease of BR serum binding capacity in chronic renal failure patients, the total concentrations of uremic toxins, CMPF, and indoxyl sulfate (IS) and the free BR concentration in serum from healthy volunteers and renal failure patients were determined. Both total CMPF and IS concentrations correlate with the free BR concentration. However, results from the peroxidase method reveal that IS cannot displace BR under the physiological condition [IS]/[HSA] <1. We, therefore, conclude that CMPF is one of the substances which contribute to the decreased binding capacity of BR in uremic serum.     

Phagocytic polymorphonuclear function in patients with progressive uremia and the effect of acute hemodialysis

BACKGROUND: Susceptibility to infections is a major cause of high morbidity and mortality in patients with chronic kidney disease (CKD). Polymorphonuclear leukocytes (PMNs) play a major role in the host defense against various infections. Although the phagocytic function of PMNs in uremic patients has been subjected to repeated evaluation, results have been inconsistent. Also, the effects of progressive uremia and acute hemodialysis (HD) on polymorphonuclear function have been scarcely evaluated. METHODS: In this study, we assessed the phagocytic index (PI) of PMNs following their uptake of IgG-coated sheep erythrocytes in patients with varying severity of CKD and in healthy controls. In patients with advanced renal failure, the effects of acute HD on PI pre- and post-HD were also studied. RESULTS: A total of 30 patients with CKD and 15 healthy controls were studied. Patients with CKD were categorized into two groups: mild to moderate renal failure (S. Creatinine 2-6 mg/dL) and advanced renal failure (S. Creatinine >6 mg/dL) (n=15 for each). All three groups were age and sex matched. Patients with advanced renal failure had significantly impaired PI (4.03 +/- 1.15) as compared to patients with mild to moderate renal failure (7.17 +/- 2.62) and normal controls (8.13 +/- 3.31) (p < 0.001 for both). There was a statistically insignificant decline in the PI in patients with mild to moderate RF when compared to controls (7.17 +/- 2.62 versus 8.13 +/- 3.31). In patients with advanced renal failure, acute HD led to a significant improvement in PI (5.52 +/- 1.55 versus 4.03 +/- 1.15, p < 0.01). CONCLUSION: In patients with CKD, there is a progressive decline in the phagocytic index of the PMNs with increasing severity of uremia. Significant improvement in the phagocytic index following acute hemodialysis suggests the role of a circulating uremic toxin in this PMN dysfunction.     

Renal artery resistance index, thyroid hormones, and thyroid volume in the early kidney transplants recipients

BACKGROUND: Thyroid hormones could affect renal function, and, on the other hand, renal dysfunction may affect thyroid function. Disturbances of concentrations of thyroid hormones are often associated with thyroid gland enlargement. The aim of the study was to assess the function and morphology of the thyroid (volume and hormones concentration) and kidney function after transplantation (creatinine concentration and resistance index [RI] of transplant artery). MATERIAL AND METHODS: The group included 13 females, 19 males; aged 19-69 years, mean 44.75 +/- 14.8 years after transplantation with stable graft function. Thyroid volume, renal artery RI, creatinine concentration, and concentrations of T3, rT3, FT3, FT4, and TSH were estimated the day before surgery, and at 1, 3, 6, and 10 days after transplantation. RESULTS: The statistical analysis revealed a negative correlation between delta RI (difference between RI at 3 and 6 days after transplantation) and serum creatinine concentration, 10 days after transplantation (r = -0.63; P < 0.01). We also observed a negative correlation between creatinine serum concentration at 10 days after transplantation and delta thyroid volume (Delta Vol; r = - 0.48; p < .05), a positive correlation between delta FT4 (Delta FT4) serum concentration, and delta creatinine (Delta Crea; r = 0.73; P < .001). CONCLUSIONS: The dynamics of RI changes in the transplant kidney artery between 3 and 6 days after transplantation may predict graft function. Together with improved kidney function at 10 days after transplantation, we observed a regression of goiter.     

Ultrasonic tissue characterization of the carotid artery in chronic renal failure patients

The ultrasonic reflectivity of the carotid wall, measured by means of integrated backscatter (IBS) analysis, has recently been evaluated in patients with atherosclerotic diseases and it was considered to be a prognostic marker. We performed B-mode measurement and IBS analysis of the carotid wall in 30 chronic renal failure (CRF) patients (serum creatinine 548 +/- 230 micromol/l) on conservative treatment and free of clinical evidence of cardiovascular complications; 14 were normotensives (NT) and 16 were treated hypertensives (TH). Thirty sex- and age-matched healthy subjects served as controls. The IBS carotid index was significantly higher in CRF patients than in controls (31.7 +/- 3.5 vs. 28.9 +/- 2.3 dB; p < 0.001), and no difference was observed between TH and NT CRF patients. The IBS index was negatively correlated with low-density lipoprotein cholesterol plasma levels (r = -0.46, p < 0.05), and within the group of TH CRF patients the IBS index was also negatively correlated with the body mass index and diastolic blood pressure. The carotid intima-media thickness was similar between uremic patients and controls. This study demonstrates an increment in carotid ultrasonic reflectivity in CRF patients, independent of the presence of overt atherosclerotic damage, and probably related to vascular remodelling linked to CRF. IBS analysis can be a useful tool to detect early changes in arterial wall structure. However, prospective studies should be planned to define its prognostic importance in uremic patients.     

Influence of sex and chronic haemodialysis treatment on total, free and acyl carnitine concentrations in human serum

The influence of sex and haemodialysis treatment on serum total, free and acyl carnitine concentrations in healthy controls and chronic renal failure patients has been investigated. Patients on regular haemodialysis treatment generally displayed significantly decreased serum carnitine levels. The mean predialysis serum carnitine levels were not significantly different from the mean healthy control values. However, after dialysis a significant decrease in serum carnitine levels was observed compared to the predialysis and healthy control values. Moreover, serum ratio of acylated to free carnitine was significantly higher after haemodialysis, as compared to both healthy controls and predialysis patients. Sex-related changes in serum total, free and acyl carnitine levels and ratios of acylated to free carnitine have been observed in healthy controls and patients on chronic haemodialysis treatment.     

Plasma dopamine, urinary dopamine and their metabolites in chronic renal failure.

To assess the clinical features of the dopamine (DA) metabolism in chronic renal failure patients (CRF), measurements were made of the plasma DA, norepinephrine (NE), epinephrine (EN) and their urinary metabolites in 6 healthy controls and 13 CRF patients before and after administration of oral DA (KW-3160, Kyowa Hakko Kogyo Co., Ltd.). The data obtained, including that for impaired DA metabolites in the patients with chronic renal failure, can be summarized as follows: I) Synthesis: In the plasma, the DA, NE and EN levels were not significantly different in the CRF patients as compared to those in normal controls, but the excretions of urinary free DA, NE and EN were markedly lower, and the free and conjugated DA, NE and EN levels were significantly decreased in the CRF patients after DA administration. These findings indicate that the plasma dopamine beta-hydroxylase activity is inhibited in CRF patients. II) Degradation: Increased levels of urinary free and conjugated 3,4-dihydroxy phenylacetic acid (DOPAC) and decreased levels of urinary conjugated homovanillic acid (HVA) were observed, indicating that the monoamine oxidase (MAO) activity in the plasma is possibly augmented, and the catecholamine O-methyl transferase (COMT) activity inhibited, in uremic patients. III) Excretion: The urinary excretions of free DOPAC, HVA, NE and vanillylmandelic acid (VMA) and of conjugated DA and DOPAC were significantly correlated with the creatinine clearance. These data suggest that the excretion of urinary DA and part of its metabolites may be regulated by the renal function.     

Euthyroid sick syndrome in trauma patients with severe inflammatory response syndrome

Objective： To investigate the alternations of thyroid hormone in traumatic patients with severe inflammatory response syndrome （SIRS）. Methods： Fifty traumatic patients with severe SIRS were enrolled and divided into two groups according to whether they presented multiorgan dysfunction syndrome （MODS）. Thyroid hormone measurements were taken, including total triiodothyronine （ TT3 ）, total thyroxine （TT4）, free triiodothyronine （FT3）, free thyroxine （ FT4 ） and thyroid stimulating hormone （TSH）. The acute physiology and chronic health evaluation II （ APACHE II ） score was calculated according to clinical data. The outcomes of recovery or deterioration were recorded, as well as the length of time from the onset of SIRS to the time thyroid hormones were measured. Results： Euthyroid sick syndrome （ESS） was presented in 45 cases. TT3 level was negatively correlated with APACHE II score （r = -0.330, P 〈0. 05）, and TT3/TI＇4 value was negatively correlated with the duration of SIRS（ r = -0.316, P〈0.05）. TT3, TT4 and levels in MODS patients were significantly lower than those without MODS （ P 〈 0.05 ）. MODS patients got low TT4 or FT4 level more frequently than those without MODS （ P 〈 0.05 ）. Compared with the patients in normal TSH group, the patients with decreased TSH had lower T3, T4, recovery rate and higher APACHE II scores, MODS incidence, but there was no difference between two groups （P〉0.05）. Conclusions： Trauma patients with severe SIRS have high possibility to get ESS, which occurs more frequently and severely in MODS patients. It shows the influences of SIRS on the thyroid axes. With the persistence and aggravation of SIRS, there is a progressive reduction of thyroid hormone.     

Bone mass status in different degrees of chronic renal failure.

Bone mineral density (BMD) was evaluated in 69 patients with chronic renal failure (CRF) and in healthy controls matched for age, sex, and, for women, menopausal status. Both appendicular (predominantly cortical) and axial (predominantly trabecular) bone mass were measured. Appendicular BMD was measured by single photon absorptiometry on the distal forearm and axial BMD was measured by dual photon absorptiometry on the lumbar spine. Patients were divided into three groups on the basis of creatinine clearance: group 1, 58 to 36 ml/min; group 2, 30 to 18 ml/min; group 3, 15 to 9 ml/min. Both appendicular and axial BMD decreased with the worsening of renal failure. Parathyroid hormone levels were inversely correlated with the values of appendicular BMD. BMD values were significantly lower in postmenopausal than in premenopausal women. Months of menopause were inversely correlated with axial BMD values. Appendicular BMD was lower in CRF patients than in controls, and both appendicular and axial BMD were significantly lower in postmenopausal uremic women than in postmenopausal healthy women.     

Effect of acute renal failure on free thyroid hormone levels in a thyrotoxic patient

Acute renal failure in a previously undiagnosed case of thyrotoxicosis was accompanied by a rapid and spontaneous decline in thyroid hormone levels. Over a 2-week period, free triiodothyronine and thyroxine fell to the low levels seen in euthyroid patients with end-stage renal disease. Thyrotropin levels remained undetectable throughout, suggesting impairment of the pituitary-thyroid axis at the level of the thyroid gland. This may represent an important beneficial adaptation to severe illness and could explain the virtual absence of hyperthyroidism in renal failure patients.     

Serum and peritoneal dialysate thyroid hormone levels in patients on continuous ambulatory peritoneal dialysis

Thyroid function tests were performed on 16 clinically euthyroid patients with end-stage renal failure undergoing regular haemodialysis or continuous ambulatory peritoneal dialysis and compared with 8 healthy subjects. The patient groups were carefully matched, especially regarding relative duration of dialysis (mean of 24 months). Total serum thyroxine, total triiodothyronine, free thyroxine, free triiodothyronine and reverse triiodothyronine were significantly lower in both patient groups than control. The thyrothrophin response to the standard thyrotrophin-releasing hormone test was delayed and blunted. Using a novel concentration technique we measured loss of T4 in peritoneal dialysate effluent and found it to be approximately 10% of daily thyroidal T4 release.