Clinical Features and Outcomes in Patient with Antineutrophil Cytoplasmic Autoantibody–Positive Glomerulonephritis Associated with Propylthiouracil Treatment in Siriraj Hospital
Nithat Visavachaipan MD*, Leena Ong-ajyooth MD*, Thawee Chanchairujuira MD*, Paisal Parichatikanond MD**, Boonyarit Choensuchon MD**
Affiliation : * Renal Division, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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 propylth-
iouracil 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withdrawn in every patient and corticosteroid was administered.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 aver-
age 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
