Clinical and pathological features of renal involvement in propylthiouracil-associated ANCA-positive vasculitis.
BACKGROUND
The kidney is one of the organs affected in patients with propylthiouracil (PTU)-associated antineutrophil cytoplasmic antibody (ANCA)-positive vasculitis. We present a series of Chinese patients with renal involvement in PTU-associated ANCA-positive vasculitis and describe their clinical and pathological characteristics.


METHODS
Clinical and pathological data from patients with PTU-associated ANCA-positive vasculitis with renal involvement, diagnosed in Peking University First Hospital, were collected and analyzed retrospectively.


RESULTS
Nineteen patients with PTU-associated ANCA-positive vasculitis were treated at Peking University First Hospital between December 1999 and December 2005, and 15 of them had renal involvement. Of the 15 patients, 13 were female and 2 were male, with an average age of 26.3 +/- 11.8 years. All 15 patients were perinuclear ANCA positive with specificities to myeloperoxidase (15 of 15), cathepsin G (9 of 15), human leukocyte elastase (8 of 15), lactoferrin (7 of 15), azurocidin (5 of 15), and proteinase 3 (4 of 15). Duration of PTU administration was 43.0 +/- 31.2 months. All 15 patients had clinical markers of renal involvement, including hematuria (100%), proteinuria (100%), and renal function abnormality (47%). All 15 patients underwent percutaneous renal biopsy. Ten patients had necrotizing crescentic glomerulonephritis, and 7 of these 10 patients had immune complex deposition. Three patients had minimal involvement, 2 patients had immunoglobulin A nephropathy, and 2 patients had membranous nephropathy. PTU treatment was discontinued in all 15 patients. All except 2 patients with minimal renal involvement received immunosuppressive treatment. Eleven of 15 patients achieved complete clinical remission.


CONCLUSIONS
Renal involvement in our case series of patients with PTU-associated ANCA-positive vasculitis was heterogeneous, and nearly half our patients had renal immune complex deposition.
Yu
Feng
F
Department of Nephrology, Peking University First Hospital, Beijing, PR China.
Chen
Min
M
Gao
Ying
Y
Wang
Su-Xia
SX
Zou
Wan-Zhong
WZ
Zhao
Ming-Hui
MH
Wang
Hai-Yan
HY
D000293:Adolescent; D000328:Adult; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood*; D002648:Child; D005260:Female; D006801:Humans; D007105:Immune Complex Diseases / Q000139:chemically induced* / Q000276:immunology / Q000473:pathology; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000187:drug effects / Q000276:immunology / Q000473:pathology; D007674:Kidney Diseases / Q000139:chemically induced* / Q000276:immunology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011441:Propylthiouracil / Q000009:adverse effects*; D012189:Retrospective Studies; D014657:Vasculitis / Q000139:chemically induced* / Q000276:immunology / Q000473:pathology*
D019268:Antibodies, Antineutrophil Cytoplasmic; D007166:Immunosuppressive Agents; D011441:Propylthiouracil