抗甲状腺药物致儿童急进性肾小球肾炎

目的探讨服用抗甲状腺药丙硫氧嘧啶(PTU)、甲巯咪唑(MMI)]致急进性肾小球肾炎(RPGN)的临床特征。方法根据2例患儿用药史、临床表现、血清学检查及肾活组织病理检查结果进行分析。结果患儿均以肉眼血尿、蛋白尿起病,伴肾功能不全,1例抗中性粒细胞胞浆抗体(ANCA)阳性,肾活检提示肾血管炎改变、肾血管坏死及新月体形成;另1例表现为系膜增殖伴新月体形成。结合发病前有服用抗甲状腺药(PTU、MMI)5年以上病史,诊断为抗甲状腺药致RPGN。经停用抗甲状腺药,予泼尼松、霉酚酸酯治疗,随访1年,尿常规及肾功能正常。结论抗甲状腺药可致RPGN,早期免疫抑制治疗可改善预后。

Rapidly Progressive Glomerulonephritis Induced by Antithyroid Agents in Children

Objective To explore the clinical characteristic of rapidly progressive glomerulonephritis(RPGN) induced by the antithyroid agentspropylthiouracil(PTU) and methimazole(MMI)].Methods The analysis was made according to the drug histories,clinical manifestation,serology investigations,renal biopsy in 2 children.Results Two cases presented with gross hematuria,proteinuria and renal dysfunction.One case with antineutrophil cytoplasmic antibody(ANCA)-positive and vasculitis lesion with cresent in the renal biopsy;another presented with mesengial proliferation and cresent.They both had been diagnosed RPGN induced by antithyroid agents for 5 years because of Graves disease.The treatment included that PTU and MMI were withdrawn and then combined prednisone with mycophenolate mofetil(MMF)were applied.One year after treatment,the urine analysis and renal function returned to normal.Conclusions The antithyroid agents may induce RPGN.A early diagnosis and immunosuppressive therapy can improve its prognosis of the disease.