[Membranoproliferative glomerulonephritis associated with autoimmune thyroiditis].
Several cases of glomerular disease have been associated to thyroid diseases. The most frequent lesion described is membranous glomerulopathy, presented as a nephrotic syndrome. Here we report a 67-year-old man who developed a nephrotic syndrome accompanied by rapid derangement of renal function shortly after the onset of a primary hypothyroidism due to autoimmune thyroiditis. High titers of circulating anti-thyroglobulin and anti-microsomal thyroid antigen antibodies were detected. Serum levels of C3 and C4 fractions of complement were markedly decreased. Renal biopsy showed a membranoproliferative glomerulonephritis with severe mesangial proliferation, a type of glomerular involvement non-described previously in the literature, in relation with thyroid diseases. Four boluses of intravenous steroids were administered, followed by oral prednisone for three months. A dramatic recovery of renal function, together with normalization of urinary sediment, proteinuria decrease and normalization of serum complement were observed. Three years later, the patient suffered from a similar event, with a positive response to steroids again. One year later, the patient had a new recurrence and was treated with mycophenolate mofetil , improving his clinical situation.
Valentín
M
M
Servicio de Nefrología, Hospital 12 de Octubre, Madrid.
Bueno
B
B
Gutiérrez
E
E
Martínez
A
A
González
E
E
Espejo
B
B
Torres
A
A
D000368:Aged; D001323:Autoantibodies / Q000097:blood; D001327:Autoimmune Diseases / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D003176:Complement C3 / Q000032:analysis / Q000172:deficiency; D003181:Complement C4 / Q000032:analysis / Q000172:deficiency; D005920:Glomerular Mesangium / Q000473:pathology; D015432:Glomerulonephritis, Membranoproliferative / Q000097:blood / Q000209:etiology* / Q000473:pathology; D006801:Humans; D018828:Immunoglobulins, Thyroid-Stimulating; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D009404:Nephrotic Syndrome / Q000097:blood / Q000209:etiology* / Q000473:pathology; D011241:Prednisone / Q000627:therapeutic use; D011989:Receptors, Thyrotropin / Q000097:blood; D012008:Recurrence; D013967:Thyroiditis, Autoimmune / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D013974:Thyroxine / Q000627:therapeutic use
D001323:Autoantibodies; D003176:Complement C3; D003181:Complement C4; D018828:Immunoglobulins, Thyroid-Stimulating; D007166:Immunosuppressive Agents; D011989:Receptors, Thyrotropin; C056626:thyroid microsomal antibodies; C094372:thyrotropin-binding inhibitory immunoglobulin; D013974:Thyroxine; D011241:Prednisone