Endocrine Abstracts

JOINT323

Background: Nephrotic syndrome (NS) is among the most prevalent renal glomerular diseases in children. Nephrotic syndrome (NS) is characterized by glomerular damage, leading to a significant loss of proteins in the urine specifically thyroxine-binding globulin (TBG) and thyroxine. Subclinical or overt hypothyroidism in this population may exacerbate the disease burden, complicate management, and impair long-term outcomes.

Objective: The objectives are: (1) to determine the pooled prevalence of hypothyroidism in children with nephrotic syndrome(2) Pooled prevalence of Clinical and Subclinical hypothyroidism in nephrotic syndrome and (3) to explore factors influence.

Methodology: This systematic review was registered in the PROSPERO database under the identifier CRD42023455277. The authors conducted searches across databases, including EMBASE, Web of Science, Cochrane CENTRAL, Scopus, and CINAHL and Google. The keyword search was limited to titles and abstracts, employing Boolean operators such as "OR" and "AND" where applicable. The search terms included Nephrotic syndrome, prevalence, hypothyroidism, children, thyroid stimulating hormone, and thyroxine.

Statisical analysis: The Quantitative Analysis includes Pooled prevalence with 95% Confidence Interval (CI) was calculated using OpenMeta software. The Heterogeneity were assessed using I² statistic test. Publication Bias was evaluated using funnel plots and Egger’s test.

Result: 26 studies were included in the review, with 19 studies included in the meta-analysis. The pooled prevalence rate is 41.45% with 95% confidence interval 32.896 to 50.287. The funnel plot does not show significant asymmetry, suggesting there is no substantial publication bias or small-study effects. The pooled prevalence of hypothyroidism among steroid resistant nephrotic syndrome(SRNS) is 38.140. The pooled prevalence of clinical hypothyroidism is 15.31% with a 95% confidence interval of 8.463 to 23.736. The pooled prevalence of sub clinical hypothyroidism was 25.96% with a 95% confidence interval of19.456 to 33.044. The standardized mean difference of TSH value between nephrotic syndrome with and without hypothyroidism group is 1.86 suggesting a moderate to large effect size. And I² = 93.62% indicates substantial variability among the studies and P < 0.01 suggests that the heterogeneity is statistically significant. In Regression analysis there is a weak downward trend between age and proportion.

Conclusion: This systematic review and meta-analysis highlights the significant burden of hypothyroidism in patients with nephrotic syndrome, with notable differences across subtypes and severity of thyroid dysfunction. Elevated TSH levels in nephrotic syndrome compared to control groups further underscore the impact of this renal condition on thyroid physiology. These findings call for routine thyroid function monitoring, particularly in high-risk subgroups like SRNS.