Scientific article
Open access

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

Published inRenal failure, vol. 35, no. 3, p. 414-417
Publication date2013

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.

  • Aged
  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/chemically induced/complications
  • Antithyroid Agents/adverse effects
  • Carbimazole/adverse effects
  • Glomerulonephritis/etiology
  • Graves Disease/drug therapy
  • Humans
  • Kidney Failure, Chronic/etiology
  • Male
Citation (ISO format)
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. 414–417. doi: 10.3109/0886022X.2012.760356
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Article (Published version)
ISSN of the journal0886-022X

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