A pediatric case of myeloperoxidase-antineutrophil cytoplasmic (ANCA) -related crescentic glomerulonephritis associated with propylthiouracil treatment for Graves' disease

• Published in: Nihon Jinzo Gakkai shi Vol. 40; no. 8; pp. 612 - 617
• Main Authors: KAWASAKI, Yukihiko, SUZUKI, Junzou, SIKE, Tatuhiko, ISOME, Masato, NOZAWA, Ruriko, SUZUKI, Sigeo, KUME, Kazunari, SUZUKI, Hitosi
• Format: Journal Article
• Language: Japanese
• Published: Japan Japanese Society of Nephrology 1998
• Subjects: Adolescent; Adult; Antibodies, Antineutrophil Cytoplasmic - analysis; Antithyroid Agents - adverse effects; Female; Glomerulonephritis - chemically induced; Glomerulonephritis - therapy; Graves Disease - drug therapy; Humans; Peroxidase - immunology; Propylthiouracil - adverse effects; propylthiouracil, myeloperoxidase-antineutrophil cytoplasmic antibody, crescentic glomerulonephritis, Graves' disease, child
• ISSN: 0385-2385; 1884-0728
• DOI: 10.14842/jpnjnephrol1959.40.612

We treated a 13-year-old girl who developed myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) -related crescentic glomerulonephritis (GN) during propylthiouracil (PTU) treatment for Graves'disease. MPO-ANCA-related crescentic GN during PTU therapy has been described previously in only one recent report of 2 children. We report this case here and describe 15 (13 adult cases) more patients with MPO-ANCA-related GN associated with PTU found in a literature review. The mean age at onset was 41.3 years, and the length of PTU administration ranged from 2 weeks to 6 years (mean 3.5 years). Clinical signs and symptoms were hematuria (100%), proteinuria (100%), arthralgia (7 of 16 cases ; 43.8%), fever (4 cases ; 20.0%), purpura (2 cases ; 12.5 %), skin ulcer (1 case ; 6.3%) and dyspnea (1 case ; 6.3%) . These patients were treated with steroid (15 cases ; 93.8%), cyclophosphamide (8 cases ; 50.0%), steroid pulse therapy (4 cases ; 25.0%), or plasma exchange (1 case ; 6.3%), or were not treated (1 case ; 6.3%) . Most patients revealed crescentic GN (15 cases ; 93.8%) on renal biopsy, while one exhibited mesangial proliferative GN (6.3%) . For 2 of the 16 patients (12.5%) irreversible renal dysfunction persisted and hemodialysis was started. Patients with Graves' disease treated with PTU should be observed carefully by urinalysis and monitoring of the serum creatinine level.