A case of Graves' disease associated with membranoproliferative glomerulonephritis and leukocytoclastic vasculitis.

Authors:
Werner Keenswijk
Werner Keenswijk
Ghent University Hospital
Ghent | Belgium
Anne Hoorens
Anne Hoorens
Vrije Universiteit Brussel
Belgium
Johan Vande Walle
Johan Vande Walle
Ghent University Hospital
Gent | Belgium

J Pediatr Endocrinol Metab 2018 Oct;31(10):1165-1168

Ghent University, Department of Pediatrics and Medical Genetics, Ghent, Belgium.

Background The association of hyperthyroidism with renal disease is very rare and the importance of timely clinical recognition cannot be overemphasized. Case presentation An 11-year-old girl presented with gastrointestinal symptoms while hypertension, edema and abdominal pain were noticed on clinical examination. Laboratory investigation revealed: hemoglobin 9.4 (11.5-15.5) g/dL, total white cell count 16 (4.5-12)×109/L, platelets 247 (150-450)×109/L, C-reactive protein (CRP) 31.8 (<5) mg/L, blood urea nitrogen (BUN) 126 (13-43) mg/dL, creatinine 0.98 (0.53-0.79) mg/dL, albumin 25 (35-52) g/dL, complement factor C3 0.7 (0.9-1.8) g/L, complement factor C4 0.1 (0.1-0.4) g/L, tri-iodothyronine 6.5 (2.5-5.2) pg/mL, free thyroxine 2.4 (1-1.7) ng/dL, thyroid stimulating hormone (TSH) <0.02 (0.5-4.3) mU/L. Urinalysis showed nephrotic range proteinuria. Renal function deteriorated necessitating hemodialysis (HD). A renal biopsy revealed an immune complex-mediated membranoproliferative glomerulonephritis (MPGN). Elevated thyroid hormones and suppressed TSH levels with elevated thyroperoxidase antibodies and thyroid stimulating immunoglobulins confirmed the diagnosis of Graves' disease. Corticosteroids were commenced and eventually thiamazole was added with gradual improvement of renal function, cessation of HD and discharge from the hospital. Conclusions Graves' disease complicated by MPGN is extremely rare, but can cause life-threatening complications.

Download full-text PDF

Source
http://dx.doi.org/10.1515/jpem-2018-0186DOI Listing
October 2018
11 Reads

Publication Analysis

Top Keywords

pain noticed
4
abdominal pain
4
edema abdominal
4
noticed clinical
4
clinical examination
4
laboratory investigation
4
examination laboratory
4
hypertension edema
4
gastrointestinal symptoms
4
case presentation
4
overemphasized case
4
presentation 11-year-old
4
11-year-old girl
4
presented gastrointestinal
4
girl presented
4
investigation revealed
4
revealed hemoglobin
4
247 150-450×109/l
4
platelets 247
4
150-450×109/l c-reactive
4

References

(Supplied by CrossRef)
Article in Clinical presentation, classification, and causes of membranoproliferative glomerulonephritis.
Clinical presentation, classification, and causes of membranoproliferative glomerulonephritis.
Membranoproliferative glomerulonephritis associated with autoimmune thyroiditis
[Article in Spanish] Nefrologia 2004
Proteinuria in autoimmune thyroid disease
Acta Endocrinol (Copenh) 1985
Pathogenesis of hyperthyroidism
Compr Physiol 2016

Similar Publications