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
patients.

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.

Results:
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withdrawn in every patient and corticosteroid was administered.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
follow-up.

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.

Keywords:
ANCA positive Glomerulonephritis, Propylthiouracil

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