Propylthiouracil induced vasculitis associated with acute kidney injury children: a case report and literature review

doi:10.3877/cma.j.issn.1674-0785.2017.11.009

Abstract

Abstract:

Objective

A report of 1 case of antineutrophil cytoplasmic antibody (ANCA)-positive vasculitis complicated with acute kidney injury caused by taking propylthiouracil (PTU).

Methods

The medical history, laboratory serology and renal biopsy were collected. The diagnosis and treatment were analyzed. The literature of Propylthiouracil induced ANCA-associated vasculitis was reviewed.

Results

A 15-year-old female patients presenting with sudden oliguria and proteinuria onset developed renal failure and positive blood MPO-ANCA rapidly. Renal biopsy revealed: (1) glomerular segment necrotic lesions and crescents (5/7), considering ANCA-associated vasculitis (propylthiouracil related), (2) glomerular capillary hypertrophy lesions, immunofluorescence showed mass C3 deposition. In light of a history of hyperthyroidism treated with PTU for 3 years, of the patient was diagnosed as: 1. propylthiouracil (PTU) induced vasculitis; 2. acute kidney injury. After treatment with immediate PTU withdrawal, 4 cycles of continuous renal replacement therapy and 3 cycles of methylprednisolone, the child recovered renal function and normal urine output. Follow-up of at 4th month showed the indicators returned to normal.

Conclusion

PTU can lead to ANCA-positive vasculitis with acute kidney injury, early diagnosis and treatment can improve the prognosis.

Key words: Propylthiouracil, Antineutrophil cytoplasmic antibodies, Vasculitis, Acute renal failure

Suling Wei, Chunlin Gao, Zhengkun Xia. Propylthiouracil induced vasculitis associated with acute kidney injury children: a case report and literature review[J]. Chinese Journal of Clinicians(Electronic Edition), 2017, 11(11): 1906-1911.

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References 34

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变量	入院检查	治疗后复查	正常范围
血红蛋白	97	101	115~150 g/L
血小板	141	158	（125~350）×10⁹/L
白细胞计数	10.2	10.8	（3.5~9.5）×10⁹/L
尿蛋白定量	1.15	1.02	<0.4g/24 h
尿沉渣（/HP）	3729.6	669	0~12/μl
肌酐清除率（ml/min）	8.77	127	80~120 ml/min
血白蛋白（g/L）	30.3	36.4	35~50 g/L
血肌酐（μmol/L）	897	54	46~92 μmol/L
尿素氮（mmol/L）	29.3	8.7	2.5~6.1 mmol/L
尿酸（μmol/L）	454	439	149~369 μmol/L
尿NAG酶	106.9	14.3	<17.8 μ/g?cr
尿RBP	2.5	0.1	<0.5 mg/L
免疫球蛋白G（g/L）	11.0	7.44	7~16 g/L
免疫球蛋白A（g/L）	2.25	1.82	0.7~4.0 g/L
免疫球蛋白M（g/L）	1.41	1.49	0.4~2.3 g/L
补体C3	0.169	0.949	0.9~1.8 g/L
补体C4	0.155	0.141	0.1~0.4 g/L
T3	0.5	0.75	1.23~3.07 mol/L
T4	107.67	74.85	71~161 nmol/L
TSH	1.12	2.61	0.3~4.5 mIU/L
抗甲状腺球蛋白抗体	56.87	/	<115 IU/ml
抗甲状腺过氧化物酶抗体	75.57	/	<34.0 IU/ml
促甲状腺激素受体抗体	0.47	/	<0.75 IU/L
抗GBM抗体	阴性	/	阴性
抗TBM抗体	阴性	/	阴性
抗髓过氧化物酶抗体　（A~MPO）	阳性	阴性	阴性
抗蛋白酶抗体（A~PR3）	阴性	/	阴性
胞浆型抗中性粒细胞胞浆抗体	阴性	/	阴性
核周型抗中性粒细胞胞浆抗体　（甲醛抗性）	阳性	阳性	阴性
核周型抗中性粒细胞胞浆抗体　（甲醛敏感）	阴性	阴性	阴性
C3肾炎因子	阴性	/	阴性
补体H因子	阴性	/	阴性
抗补体H因子抗体	阴性	/	阴性
淋巴细胞免疫分型CD4	125.0	617	（651.3±273.6）个/μl

变量	入院检查	治疗后复查	正常范围
血红蛋白	97	101	115~150 g/L
血小板	141	158	（125~350）×10⁹/L
白细胞计数	10.2	10.8	（3.5~9.5）×10⁹/L
尿蛋白定量	1.15	1.02	<0.4g/24 h
尿沉渣（/HP）	3729.6	669	0~12/μl
肌酐清除率（ml/min）	8.77	127	80~120 ml/min
血白蛋白（g/L）	30.3	36.4	35~50 g/L
血肌酐（μmol/L）	897	54	46~92 μmol/L
尿素氮（mmol/L）	29.3	8.7	2.5~6.1 mmol/L
尿酸（μmol/L）	454	439	149~369 μmol/L
尿NAG酶	106.9	14.3	<17.8 μ/g?cr
尿RBP	2.5	0.1	<0.5 mg/L
免疫球蛋白G（g/L）	11.0	7.44	7~16 g/L
免疫球蛋白A（g/L）	2.25	1.82	0.7~4.0 g/L
免疫球蛋白M（g/L）	1.41	1.49	0.4~2.3 g/L
补体C3	0.169	0.949	0.9~1.8 g/L
补体C4	0.155	0.141	0.1~0.4 g/L
T3	0.5	0.75	1.23~3.07 mol/L
T4	107.67	74.85	71~161 nmol/L
TSH	1.12	2.61	0.3~4.5 mIU/L
抗甲状腺球蛋白抗体	56.87	/	<115 IU/ml
抗甲状腺过氧化物酶抗体	75.57	/	<34.0 IU/ml
促甲状腺激素受体抗体	0.47	/	<0.75 IU/L
抗GBM抗体	阴性	/	阴性
抗TBM抗体	阴性	/	阴性
抗髓过氧化物酶抗体　（A~MPO）	阳性	阴性	阴性
抗蛋白酶抗体（A~PR3）	阴性	/	阴性
胞浆型抗中性粒细胞胞浆抗体	阴性	/	阴性
核周型抗中性粒细胞胞浆抗体　（甲醛抗性）	阳性	阳性	阴性
核周型抗中性粒细胞胞浆抗体　（甲醛敏感）	阴性	阴性	阴性
C3肾炎因子	阴性	/	阴性
补体H因子	阴性	/	阴性
抗补体H因子抗体	阴性	/	阴性
淋巴细胞免疫分型CD4	125.0	617	（651.3±273.6）个/μl

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