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

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.
AuthorsThomas A Mavrakanas, Yassine Bouatou, Caroline Samer, Sophie de Seigneux, Patrick Meyer
JournalRenal failure (Ren Fail) Vol. 35 Issue 3 Pg. 414-7 ( 2013) ISSN: 1525-6049 [Electronic] England
PMID23343442 (Publication Type: Case Reports, Journal Article, Review)
Chemical References
  • Antithyroid Agents
  • Carbimazole
Topics
  • 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

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