Kato H, Osajima A, Tanaka H, Serino R, Kabashima N, Tamura M, Segawa K, Anai H, Takasugi M, Nakajima Y
Second Department of Internal Medicine University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
Nihon Jinzo Gakkai Shi. 1997 Jul;39(5):517-22.
We have experienced a case of myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA)-related glomerulonephritis induced by propylthiouracil (PTU). A 45-year-old female had been treated with PTU for 4 years after the diagnosis of hyperthyroidism. She was referred to out hospital because of abrupt macroscopic hematuria and moderate proteinuria after several days of upper respiratory tract infection. On admission, her laboratory findings showed deterioration of renal function. Renal biopsy revealed crescentic glomerulonephritis without deposition of immune complexes. Her serology was found to be MPO-ANCA-positive and cytoplasmic-ANCA-negative. Based of these findings, we diagnosed idiopathic crescentic glomerulonephritis. Following the initiation of steroid pulse therapy, her urinary protein excretion and renal function gradually improved in parallel with a decrease in the MPO-ANCA titer. Although steroid therapy effectively responded to their renal function without the withdrawal of PTU, it seems that PTU may be closely associated with the development of (MPO-ANCA)-related glomerulonephritis in this case. Therefore, hyperthyroidism patients treated with PTU should be paced under vigilant observation by monitoring their urinalysis and serum creatinine level.
我们遇到过一例由丙硫氧嘧啶（PTU）诱发的髓过氧化物酶抗中性粒细胞胞浆抗体（MPO-ANCA）相关性肾小球肾炎。一名45岁女性在诊断为甲状腺功能亢进症后接受PTU治疗4年。在出现上呼吸道感染几天后，她因突然出现肉眼血尿和中度蛋白尿而被转诊至我院。入院时，她的实验室检查结果显示肾功能恶化。肾活检显示为新月体性肾小球肾炎，无免疫复合物沉积。她的血清学检查发现MPO-ANCA阳性，胞浆型ANCA阴性。基于这些发现，我们诊断为特发性新月体性肾小球肾炎。在开始使用类固醇冲击治疗后，她的尿蛋白排泄和肾功能随着MPO-ANCA滴度的降低而逐渐平行改善。尽管在未停用PTU的情况下类固醇治疗对其肾功能有有效反应，但在该病例中PTU似乎可能与（MPO-ANCA）相关性肾小球肾炎的发生密切相关。因此，接受PTU治疗的甲状腺功能亢进症患者应通过监测尿液分析和血清肌酐水平进行密切观察。
