Korean J Nephrol.  2010 May;29(3):386-391.

A Case of ANCA-positive RPGN after Propylthiouracil Treatment

• Jung GW
• Cho S
• Kim SR
• Kwon OW
• Woo JG
• Yi JE

Abstract

Anti neutrophil cytoplasmic antibody (ANCA)-positive vasculitis and crescentic glomerulonephritis has been rarely reported in patients suffering from Graves' disease and treated with Propylthiouracil. We experienced a case of ANCA-positive crescentic glomerulonephritis presenting good prognosis after discontinuing Propylthiouracil. A 40-year-old female visited due to the proteinuria and hematuria in urinalysis. She had been medicated Propylthiouracil for 3 years. Blood pressure was 100/60 mmHg. BUN and serum creatinine were 24.7 mg/dL, and 1.9 mg/dL, respectively. Urinalysis revealed protein 1481 mg/day, many RBC's/HPF (dysmorphic 80%), Serological ANCA was positive, anti-myeloperoxidase (MPO) antibody 1,922 AAU/ mL (normal <150 AAU/mL). The histologic finding showed crescentic glomerulonephritis on light microscopy, but no immuno deposit on immunofluorescence and light microscopy. So we diagnosed ANCA positive pauci-immune glomerulonephritis. Propylthiouracil was discontinued and steroid, cyclophosphamide was medicated within about 1 month, but stopped due to cytopenia. Patient's creatinine level was maintained 1.3 mg/dL and showed stable progress for about over 18 months. We report this case that showed good prognosis after discontinuation of Propylthiouracil.

Keyword

Propylthiouracil; Glomerulonephritis; ANCA

MeSH Terms

Adult
Antibodies, Antineutrophil Cytoplasmic
Blood Pressure
Creatinine
Cyclophosphamide
Female
Fluorescent Antibody Technique
Glomerulonephritis
Graves Disease
Hematuria
Humans
Light
Microscopy
Prognosis
Propylthiouracil
Proteinuria
Stress, Psychological
Urinalysis
Vasculitis
Antibodies, Antineutrophil Cytoplasmic
Creatinine
Cyclophosphamide
Propylthiouracil