Korean Journal of Nephrology 2010;29(3):386-391.
A Case of ANCA-positive RPGN after Propylthiouracil Treatment
Gyung Won Jung, M.D., Seong Cho, M.D., Sung Rok Kim, M.D., Oh Wen Kwon, M.D., Jae Gon Woo, M.D. and Ji Eun Yi, M.D.
Department of Internal Medicine, Masan Samsung Hospital Sungkyunkwan University School of Medicine, Masan, Korea
증례 : Propylthiouracil 복용 후 발생한 ANCA positive RPGN 1예
정경원, 조성, 김성록, 권오언, 우재곤, 이지은
성균관대학교 의과대학 마산삼성병원 내과
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.
Key Words: Propylthiouracil, Glomerulonephritis, ANCA
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