Subclinical hypothyroidism as a rare cofactor in chronic kidney disease (CKD) - related anemia.

BACKGROUND: Both chronic kidney disease (CKD) and hypothyroidism may cause anemia. However, the combination of the three above-mentioned phenomena in children has not been described yet.

METHODS: Our aim was to present a case of a 16-year-old girl hospitalized due to the renal impairment in the course of chemotherapy. Chronic kidney disease and severe anemia were diagnosed and erythropoiesis-stimulating agents (ESA) were administered. In view of unsatisfactory therapeutic effect, rare potential causes of hyporesponsiveness to ESA were analyzed. Laboratory tests revealed subclinical hypothyroidism. The thyroid hormone replacement therapy was applied and normalization of thyroid function was observed. Further increase of hemoglobin levels permitted discontinuation of ESA treatment. At the same time, partial amelioration of kidney function, as well as clinical improvement, were noticed.

CONCLUSION: The thyroid gland function should be assessed both in differential diagnostics of anemia and in case of unsatisfactory treatment with ESA.