Propylthiouracil 복용 후 발생한 ANCA positive RPGN

• Published in: Kidney research and clinical practice Vol. 29; no. 3; pp. 386 - 391
• Main Authors: 정경원, Gyung Won Jung, 조성, Seong Cho, 김성록, Sung Rok Kim, 권오언, Oh Wen Kwon, 우재곤, Jae Gon Woo, 이지은, Ji Eun Yi
• Format: Journal Article
• Language: Korean
• Published: 대한신장학회 30-05-2010
• Subjects: ANCA; Glomerulonephritis; Propylthiouracil
• ISSN: 2211-9132

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.