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Nishimura S, Nakao K, Takeda M, et al. Antithyroid drug-associated MPO-ANCA-positive tubulointerstitial nephritis in a type 2 diabetes patient: a case report. CEN Case Rep. 2016;6(1):22-28doi: 10.1007/s13730-016-0237-y.
Nishimura, S., Nakao, K., Takeda, M., Matsuura, I., Nomura, Y., Shojima, S., Yamamura, Y., Fujita, K., Momoki, N., Maruyama, K., Yamamura, M., & Hiramatsu, M. (2017). Antithyroid drug-associated MPO-ANCA-positive tubulointerstitial nephritis in a type 2 diabetes patient: a case report. CEN case reports, 6(1), 22-28. https://doi.org/10.1007/s13730-016-0237-y
Nishimura, Shinsuke, et al. "Antithyroid drug-associated MPO-ANCA-positive tubulointerstitial nephritis in a type 2 diabetes patient: a case report." CEN case reports vol. 6,1 (2017): 22-28. doi: https://doi.org/10.1007/s13730-016-0237-y
Nishimura S, Nakao K, Takeda M, Matsuura I, Nomura Y, Shojima S, Yamamura Y, Fujita K, Momoki N, Maruyama K, Yamamura M, Hiramatsu M. Antithyroid drug-associated MPO-ANCA-positive tubulointerstitial nephritis in a type 2 diabetes patient: a case report. CEN Case Rep. 2017 May;6(1):22-28. doi: 10.1007/s13730-016-0237-y. Epub 2016 Oct 03. PMID: 28509121; PMCID: PMC5438802.
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CEN Case Rep. 2017 May;6(1):22-28. doi: 10.1007/s13730-016-0237-y. Epub 2016 Oct 03.

Antithyroid drug-associated MPO-ANCA-positive tubulointerstitial nephritis in a type 2 diabetes patient: a case report.

CEN case reports

Shinsuke Nishimura, Kazushi Nakao, Masaya Takeda, Ikuko Matsuura, Yoshihisa Nomura, Sonei Shojima, Yuriko Yamamura, Kazuyuki Fujita, Noriya Momoki, Keisuke Maruyama, Masahiro Yamamura, Makoto Hiramatsu

Affiliations

  1. Department of Internal Medicine, Okayama Saiseikai General Hospital, 2-25 Kokutai-cho, Kita-Ward, Okayama, Okayama, 700-8511, Japan. [email protected].
  2. Department of Internal Medicine, Okayama Saiseikai General Hospital, 2-25 Kokutai-cho, Kita-Ward, Okayama, Okayama, 700-8511, Japan.

PMID: 28509121 PMCID: PMC5438802 DOI: 10.1007/s13730-016-0237-y

Abstract

A 54-year-old man diagnosed with type 2 diabetes and hyperthyroidism was prescribed propylthiouracil (PTU) after the patient developed hepatic dysfunction on thiamazole. At 50 mg/day of PTU, he was stable with thyroid-stimulating hormone receptor and thyrotropic antibody titers remaining stable. After four years of taking PTU, he was referred to the Department of Nephrology due to a rapid increase in his serum creatinine (Cr) level. He showed impaired renal function (Cr 2.26 mg/dL; estimated glomerular filtration rate (eGFR), 25 mL/min). In addition, urinary β2-microglobulin (β2 MG) was increased to 71,980 μg/L and was positive for myeloperoxidase (MPO)-anti-neutrophil cytoplasmic antibody (ANCA) (33.9 U/mL). Gallium scintigraphy demonstrated a remarkable accumulation in both kidneys. The patient was diagnosed with tubulointerstitial nephritis based on a renal biopsy, the results of which suggested that it might have been induced by PTU. He was treated with prednisolone (PSL) at 30 mg/day. As a result, within two weeks, Cr, eGFR, and urinary β2 MG levels were progressively improved to 1.72 mg/dL, 34 mL/min, and 22,020 μg/L, respectively. Therefore, we tapered off the PSL with a dose of 5 mg/day after approximately one year. There have been no exacerbated renal function parameters. Although there are many reports on patients developing MPO-ANCA-positive crescentic glomerulonephritis after the administration of PTU, we report on a relatively rare case in which interstitial nephritis occurred after the administration of PTU.

Keywords: Hyperthyroidism; MPO-ANCA; Propylthiouracil; Tubulointerstitial nephritis; Type 2 diabetes

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