Özet:

A seventeen-year-old girl was referred to the hospital with complaints of nausea, vomiting, inappetence, malaise and sweating. She was diagnosed with Graves’s disease at another hospital 11 years prior to her current presentation, and she was on treatment with propylthiouracil (PTU). According to the results of laboratory investigations (urea: 45 mg/dL, creatinine: 1.3 mg/dL, GFR: 41 mL/min/1.73 m2) she was diagnosed with stage 3 chronic renal failure. Renal biopsy was also consistent with chronic glomerulonephritis. Serologic evaluation revealed positive cytoplasmic antineutrophil cytoplasmic antibodies (C-ANCA). ANCA positive pauci-immune glomerulonephritis associated with PTU treatment was considered. Radioactive ablation treatment was performed because of persistent hyperthyroidism. PTU treatment was discontinued and enalapril, propranolol and steroid treatments were initiated. After one month, her proteinuria, C-ANCA and serum creatinine levels were regressed and renal function wasimproved. Currently, she is followed with tapering dose of prednisone as well as enalapril, and propranolol therapy. This case highlights that ANCA-positive glomerulonephritis should be considered as a potential side-effect of PTU. Patients treated with PTU should be carefully monitored for ANCA titers and the variable manifestations of ANCA-associated glomerulunephritis regardless of the period of administration.

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