Carbimazole-Induced, ANCA-Associated, Crescentic Glomerulonephritis: Case Report and Literature Review

Figures & data

Figure 1.  Serum creatinine levels and ANCA titer on different occasions. Note that creatinine levels were in the normal range before starting carbimazole (01 April). Immunologic remission was achieved after carbimazole withdrawal (ANCA titer non-detectable).Note: *Patient on intermittent renal replacement therapy.

Figure 2.  Renal biopsy on day 4 showing necrotizing crescentic pauci-immune glomerulonephritis (acid fuchsin-Orange G staining).

Table 1.  Antithyroid, drug-induced, ANCA-associated glomerulonephritis: literature review.

Reference	N	Agent	Age/sex	Symptoms	Creatinine	ANCA subtype	Follow-up (creatinine)
2	1	CMI for 10 y	52/F	Flu-like	265	p (MPO)	88 at 6 mo
3	2	PTU for 1 y, CMI for 3 mo	40–62/M	Arthralgia, dyspnea, fever	100, 1040	p (MPO), c	N/A, 220 at 1 mo
5	2	MMI, PTU	N/A	Terminal renal failure		N/A	N/A
7	1	PTU for 7 y	71/F	N/A	220	p (MPO)	140 at 2 mo
8	15	PTU for 2–96 mo	9–57/1M-14F	Constitutional, hematuria	ARF in 3 pts	MPO in all pts, PR3 in 3 pts	Partial remission in 1 pts, 2 HD dependent
9	2	PTU for 3 y, PTU for 1 mo	8/M-15/F	Arthralgia, fatigue	345, 80	p (MPO)	HD at 6 mo, 88 at 1 y
10	1	PTU	60/M	Altered consciousness	770	p (MPO)	Death
12	1	BTU for 3 y	70/M	Delirium	226	p (MPO)	126 at 7 mo
13	1	BTU for 8 mo	50/M	Hematuria	413	p (MPO)	84 at 2 mo
14	1	BTU for 1 y	22/F	Nausea, vomiting	1040	p (MPO)	200 at 3 mo
15	1	BTU for 2 y	28/F	Oliguria, dyspnea	1000	p (MPO)	186 at 18 mo
16	1	PTU for 3 mo	62/F	Oliguria	601	p	106 at 1 mo
17	1	PTU for 3 y	14/F	Hematuria, edema	247	p (MPO), c(PR3)	161 at 3 y
18	1	MMI for 7 y	56/M	Constitutional	239	p (MPO), c(PR3)	186 at 4 mo
19	1	PTU for 3 mo	50/M	Fever, nausea, vomiting	192	p	89 at 1 mo
20	1	BTU for 3 y	36/F	Dyspnea, edema	200	p (MPO)	204 at 14 mo
21	3	PTU for 2–4 y	22–82/1M-2F	Malaise, hematuria	106–319	p (MPO)	89–106 at 1 y

Notes: Creatinine values are in μmol/L. N, number of cases reported; CMI, carbimazole; BTU, benzylthiouracil; PTU, propylthiouracil; MMI, methimazole; y, year; mo, months; d, days; F, female; M, male; ANCA, anti-neutrophil cytoplasmic antibodies; MPO, myeloperoxidase; PR3, proteinase-3; GN, glomerulonephritis; FSGN, focal segmental glomerulonephritis; N/A, not available; pts, patients; HD, hemodialysis; ARF, acute renal failure.