ANCA positive renal vasculitis in Carbimazole treated patient

Dr Jayashekara



P.K, 22 yr old female, diagnosed to have Thyrotoxicosis by her GP after a month history of feeling generally unwell and weight loss from the third week of August. Bloods confirmed hyperthyroidism and anaemia hence she was started on Carbimazole 20 mg OD. She was admitted to Bedford Hospital two weeks later with nausea, vomiting, fever and rigors. She had transient rashes on both legs.  Her bloods showed she had a Creatinine of 547, which worsened over the next two days .Her ultrasound kidneys showed - bilateral oedematous kidneys.


She was transferred to Lister Hospital for renal replacement treatment. Bloods done on 15/09/2011 showed cANCA positive PR 3 antibody >28, MPO <7, GBM <7.  On 20/09/2011 repeat thyroid function tests showed TSH <0.03 Free T4-16.8. As a result Carbimazole was stopped. Renal Biopsy showed concentric necrotising glomerulonephritis consistent with ANCA related vasculitis. She was treated with prednisolone and cyclophosphamide .Her renal function continued to improve and her Creatinine is 310 and her urea 20. She is still cANCA positive and her PR3 antibody has now normalised.