丙基硫氧嘧啶相关性血管炎合并急性肾损伤一例并文献复习

Propylthiouracil induced vasculitis associated with acute kidney injury children: a case report and literature review

目的报告1例由于服用丙基硫氧嘧啶(PTU)导致抗中性粒细胞胞浆抗体(ANCA)阳性的血管炎合并急性肾损伤。方法收集患者的病史、实验室血清学及肾活组织病理检查结果,分析其诊断及治疗,并对PTU相关性血管炎文献进行综述。结果 15岁女性患者,以突发少尿、蛋白尿起病,迅速进展至肾功能衰竭,血MPO-ANCA检查阳性,肾活检病理提示:(1)肾小球节段坏死性病变及新月体(5/7),结合病史考虑ANCA相关性血管炎(PTU相关);(2)肾小球节段毛细血管内增生性病变,免疫荧光以C3沉积为主。结合患儿有原发性甲状腺功能亢进病史,服用PTU治疗3年,明确诊断为"(1)PTU相关性血管炎;(2)急性肾损伤",立即停用PTU,给予血浆置换4次及甲泼尼龙冲击治疗3个疗程后,患儿肾功能恢复,尿量正常。随访4个月各项检查指标恢复正常。结论 PTU可导致ANCA阳性的血管炎合并急性肾损伤,及时诊治可改善预后。

Objective A report of1case of antineutrophil cytoplasmic antibody(ANCA)-positive vasculitis complicated with acute kidney injury caused by taking propylthiouracil(PTU).Methods The medical history,laboratory serology and renal biopsy were collected.The diagnosis and treatment were analyzed.The literature of Propylthiouracil induced ANCA-associated vasculitis was reviewed.Results A15-year-old female patients presenting with sudden oliguria and proteinuria onset developed renal failure and positive blood MPO-ANCA rapidly.Renal biopsy revealed:(1)glomerular segment necrotic lesions and crescents(5/7),considering ANCA-associated vasculitis(propylthiouracil related),(2)glomerular capillary hypertrophy lesions,immunofluorescence showed mass C3deposition.In light of a history of hyperthyroidism treated with PTU for3years,of the patient was diagnosed as:1.propylthiouracil(PTU)induced vasculitis;2.acute kidney injury.After treatment with immediate PTU withdrawal,4cycles of continuous renal replacement therapy and3cycles of methylprednisolone,the child recovered renal function and normal urine output.Follow-up of at4th month showed the indicators returned to normal.Conclusion PTU can lead to ANCA-positive vasculitis with acute kidney injury,early diagnosis and treatment can improve the prognosis.