J Med Assoc Thai 2010; 93 (1):139

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Clinical Features and Outcomes in Patient with Antineutrophil Cytoplasmic Autoantibody–Positive Glomerulonephritis Associated with Propylthiouracil Treatment in Siriraj Hospital
Visavachaipan N Mail, Ong-ajyooth L , Chanchairujuira T , Parichatikanond P , Choensuchon B

Background: ANCA is detected in several vasculitic diseases, including drug-induced systemic vasculitis :
propylthiouracil (PTU), hydralazine, minocycline, penicillamine, allopurinol, procainamide, carbimazole,
thiamazole, clozapine and phenytoin. All have been known to induce ANCA positive vasculitis in adult

Objective: To study the clinical manifestation, renal pathology and outcome of patients with ANCA positive
vasculitis associated with propylthiouracil treatment in Siriraj Hospital.

Material and Method:
Retrospective study in 7 patients with Graves’ disease who were treated with propylthiouracil
and developed ANCA-positive glomerulonephritis between 2000-2008.

Seven cases with Graves’ disease who received propylthiouracil whose ages were 43 + 14 years. The
duration of propylthiouracil treatment was 68.5 + 39 months and the doses were 50-150 mg per day. Six cases
had P-ANCA and one case had C-ANCA in the serum. Proteinuria ranged from 0.49-2.9 gram per day. Mean
serum creatinine was 2.05 mg/dl with creatinine clearance of 44 + 35 ml/min. The propylthiouracil was
withdrawn in every patient and corticosteroid was administered. Renal remission was found until 1 year of

Conclusion: ANCA positive glomerulonephritis associated with propylthiouracil is not uncommon. The average
onset of glomerulonephritis is 2 years or more. The propylthiouracil dosage was not necessary high.
Urinalysis and other glomerulonephritis symptoms should be screened for early diagnosis and appropriate
treatment in patients treated with PTU.

ANCA positive Glomerulonephritis, Propylthiouracil

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