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Carbimazole-induced, ANCA-associated, crescentic glomerulonephritis: case report and literature review

Mavrakanas, Thomas A
Published in Renal Failure. 2013, vol. 35, no. 3, p. 414-7
Abstract Anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis is a rare complication of antithyroid drug use that was first described with propylthiouracil. We describe an ANCA-associated rapidly progressive glomerulonephritis in a patient treated with carbimazole during 6 months for Graves disease that resulted in end-stage renal disease. A 66-year-old man treated with carbimazole for Graves disease was admitted for macroscopic hematuria and edema of the lower extremities. Laboratory work-up showed elevated serum creatinine (435 μmol/L), mixed hematuria, nephrotic range proteinuria, and a low positive c-ANCA titer with proteinase-3 specificity. Renal biopsy showed necrotizing, crescentic, pauci-immune glomerulonephritis. Carbimazole was discontinued and hemodialysis was initiated as well as high-dose glucocorticoids and pulses of intravenous cyclophosphamide. Despite immunosuppressive treatment, the patient remained dialysis-dependent at 6 months after diagnosis. Graves disease remained in remission after carbimazole withdrawal. ANCA-associated vasculitis manifesting as glomerulonephritis is a potential adverse effect of all antithyroid drugs. Although prognosis is usually good, end-stage renal disease may ensue in rare cases. Physicians should have a high index of suspicion in patients receiving antithyroid drugs who present with symptoms or signs suggestive of progressive renal disease.
Keywords AgedAnti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/chemically induced/complicationsAntithyroid Agents/adverse effectsCarbimazole/adverse effectsGlomerulonephritis/etiologyGraves Disease/drug therapyHumansKidney Failure, Chronic/etiologyMale
PMID: 23343442
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Research group Groupe Desmeules Jules (pharmacologie/toxicologie) (567)
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MAVRAKANAS, Thomas A et al. Carbimazole-induced, ANCA-associated, crescentic glomerulonephritis: case report and literature review. In: Renal Failure, 2013, vol. 35, n° 3, p. 414-7. doi: 10.3109/0886022X.2012.760356 https://archive-ouverte.unige.ch/unige:90157

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Deposited on : 2016-12-08

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