ANCA-positive glomerulonephritis and IgA nephropathy in a patient on propylthiouracil.
A 14-year-old girl developed acute renal failure after 3 years therapy with propylthiouracil (PTU) for Grave's disease. Serologic evaluation showed antineutrophil cytoplasmic antibodies (ANCA) directed against proteinase 3 and myeloperoxidase. Renal biopsy showed a crescentic glomerulonephritis (GN) as well as evidence of IgA nephropathy (IgAN). PTU was discontinued and the patient was treated with prednisone and cyclophosphamide. ANCA became negative and renal function improved, but did not normalize. A second biopsy showed evidence of IgA nephropathy only. Propylthiouracil use has been associated with ANCA positive pauci-immune glomerulonephritis, but not with IgA nephropathy. An overlap syndrome between IgAN and ANCA-positive GN, however, has been described. This patient may have had a preexisting IgAN, with acute pauci-immune GN secondary to PTU, or this may be the first description of an overlap syndrome of IgAN and ANCA vasculitis all caused by PTU therapy.
Winters
Michael J
MJ
Division of Nephrology, British Columbia's Children's Hospital, Room 1A-14, 4480 Oak Street, Vancouver, British Columbia, Canada.
Hurley
R Morrison
RM
Lirenman
David S
DS
D058186:Acute Kidney Injury / Q000139:chemically induced; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000032:analysis*; D013956:Antithyroid Agents / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D005260:Female; D005921:Glomerulonephritis / Q000139:chemically induced* / Q000276:immunology*; D005922:Glomerulonephritis, IGA / Q000139:chemically induced*; D006111:Graves Disease / Q000188:drug therapy*; D006801:Humans; D011441:Propylthiouracil / Q000009:adverse effects* / Q000627:therapeutic use
D019268:Antibodies, Antineutrophil Cytoplasmic; D013956:Antithyroid Agents; D011441:Propylthiouracil