MYELOPEROXIDASE-ANTINEUTROPHIL CYTOPLASMIC ANTIBODY-POSITIVE CRESCENTIC GLOMERULONEPHRITIS COMPLICATING THE COURSE OF GRAVES-DISEASE - REPORT OF 3 ADULT CASES

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis has b een recently recognized in Graves' disease patients treated with propy lthiouracil. We have experienced three adult cases of Graves' disease with main features being renal derangements, All three patients, who w ere between the ages of 22 and 82 years, had been treated with propylt hiouracil for 2 to 5 years after a diagnosis of Graves' disease. After several weeks of upper respiratory tract infection or flu-like sympto ms, they abruptly began to manifest proteinuria and hematuria concomit ant with severe anemia. Their serum creatinine increased from normal l evels to 1.2 to 3.6 mg/dL. Renal biopsy revealed crescentic glomerulon ephritis without deposition of immune complexes (ie, pauci-immune type ). Crescent formations were observed in 40% to 60% of the glomeruli in al three cases, The serum from the patients revealed positive perinuc lear-ANCA and negative cytoplasmic-ANCA (C-ANCA) pattern, and myeloper oxidase (MPO)-ANCA titers were 120 to 502 ELISA Units/mL (normal, < 10 ELISA Units/mL). A withdrawal of propylthiouracil with or without imm unosuppressive therapy ameliorated their renal derangements. Graves' d isease patients should be placed under vigilant observation by monitor ing their urinalysis and serum creatinine, especially when being treat ed with antithyroid drugs and when suffering from flu-like symptoms. ( C) 1995 by the National Kidney Foundation, Inc.