Subclinical hypothyroidism in pediatric nephrotic syndrome: the correlations with albumin, globulin, and proteinuria

Main Article Content

Erni Nuraeni
Faiisal Faisal
Ahmedz Widiasta
Novina Novina


Background Nephrotic syndrome causes loss of medium-sized plasma proteins and binding proteins, resulting in thyroid hormone deficiency.

Objective To assess for potential correlations between subclinical hypothyroidism in pediatric nephrotic syndrome with albumin, globulin, and proteinuria.

Methods This cross-sectional study was conducted in the Department of Pediatrics, Hasan Sadikin General Hospital, Bandung, West Java. All types of nephrotic syndrome patients aged 1 month to < 18 years were included. Blood and urine specimens were collected from the patients for albumin, globulin, thyroid function (T3, fT4 and TSH), and proteinuria tests and analyzed with standard techniques.

Results There were 26 subjects, 20 males and 6 females. Ten subjects developed subclinical hypothyroidism, with mean albumin and thyroid-stimulating hormone (TSH) levels of 0.92 g/dL and 6.9 mIU/L, respectively. There was a negative correlation between albumin level and subclinical hypothyroidism (rpb=-0.702; P<0.001) and a positive correlation between proteinuria and subclinical hypothyroidism (r=0.573; P=0.003). Univariate logistic regression analysis revealed that globulin had no impact on the presence of subclinical hypothyroidism, but albumin and proteinuria did have such an impact. The odds ratios of albumin and proteinuria with subclinical hypothyroidism were 27.00 (95%CI 1.69 to 17.7) and 19.80 (95%CI 1.94 to 201.63), respectively.

Conclusion Subclinical hypothyroidism correlates with serum albumin level and proteinuria in nephrotic syndrome patients. Tha low serum albumin level has a high likelihood of subclinical hypothyroidism.  

Article Details

How to Cite
Nuraeni E, Faisal F, Widiasta A, Novina N. Subclinical hypothyroidism in pediatric nephrotic syndrome: the correlations with albumin, globulin, and proteinuria. PI [Internet]. 17Apr.2020 [cited 23Sep.2020];60(2):91-. Available from:
Pediatric Nephrology
Received 2019-09-30
Accepted 2020-04-17
Published 2020-04-17


1. Andolino TP, Reid-Adam J. Nephrotic Syndrome. Pediatr Rev. 2015;36:117–26. DOI: 10.1016/j.pcl.2018.08.006.
2. Jung SH, Lee JE, Chung WY. Changes in the thyroid hormone profiles in children with nephrotic syndrome. Korean J Pediatr. 2019;62:85–9. DOI: 10.3345/KJP.2018.06891.
3. Mariani LH, Berns JS. The Renal Manifestations of Thyroid Disease. J Am Soc Nephrol. 2012;23:22–6. DOI: 10.1681/ASN.2010070766.
4. Lennon R, Watson L, Webb NJ. Nephrotic syndrome in children. Paediatr Child Health (Oxford). 2009;20:36–42. DOI: 10.1016/j.paed.2009.10.001.
5. Dagan A, Cleper R, Krause I, Blumenthal D, Davidovits M. Hypothyroidism in children with steroid-resistant nephrotic syndrome. Nephrol Dial Transpl. 2012;27:2171–5. DOI: 10.1093/ndt/gfr665.
6. Kapoor K, Saha A, Dubey NK, Goyal P, Suresh CP, Batra V, et al. Subclinical non-autoimmune hypothyroidism in children with steroid resistant nephrotic syndrome. Clin Exp Nephrol. 2013;1–5. DOI: 10.5530/ijmedph.2017.2.25.
7. Li L, Hu Y, Ai S, Cheng L, Liu J, Morris E, et al. The relationship between thyroid dysfunction and nephrotic syndrome : a clinicopathological study. Sci Rep. 2019;9(6421):1–7. DOI: 10.1038/s41598-019-42905-4.
8. Rukmani J, Krishanamurthy C, Clarin D. Thyroid function test in nephrotic syndrome children who are admitted in emergency ward of Government Tirunelveli Medical College and Hospital, India. Int J Contemp Pediatr. 2018;5:2290–3. DOI: 10.18203/2349-3291.ijcp20184298.
9. Gilles R, Heijer M de., Ross A., Sweep FCG., Hermus ARM., Wetzels JF. Thyroid function in patients with proteinuria. Netherlands J Med Netherlands J Med. 2008;66:483–5. DOI: 10.1210/jcem-23-3-311.
10. Sahni V, Nanda S, Gehlawat V kumar, Gathwala G. Hypothyroidism in Nephrotic Syndrome in Children. OSR J Dent Med Sci. 2014;13:7–11. DOI: 10.9790/0853-13810711.
11. Shriraam M, MSridhar. Subclinical Hypothyroidism in Children. Indian Pediatr. 2014;51:889–95. DOI: 10.1210/endo-20-6-816.
12. Kaplowitz PB. Subclinical Hypothyroidism in Children : Normal Variation or Sign of a Failing Thyroid Gland ? Intenational J Pediatr Endocrinol. 2010;1–8. DOI: 10.1155/2010/281453.
13. Trihono PP, Alatas H, Tambunan T, Pardede SO. Konsensus: tata laksana sindrom nefrotik idiopatik pada anak. 2nd ed. Jakarta: Unit Kerja Koordinasi Nefrologi IDAI; 2012. p. 1–36.
14. Ito S, Kano K, Ando T, Ichimura T. Thyroid function in children with nephrotic syndrome. Pediatr Nephrol. 1994;8:412–5. DOI: 10.1007/BF00856516.
15. Liu H, Yan W, Xu G, Liu H, Yan W, Xu G. Thyroid hormone replacement for nephrotic syndrome patients with euthyroid sick syndrome : a meta-analysis Thyroid hormone replacement for nephrotic syndrome patients with euthyroid sick syndrome : a meta-analysis. Ren Fail. 2014;36:1360–5.DOI: 10.3109/0886022X.2014.949559.