A case of Graves’ disease associated with membranoproliferative glomerulonephritis and leukocytoclastic vasculitis
-
Werner Keenswijk
,
Eva Degraeuwe
Abstract
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.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
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Articles in the same Issue
- Frontmatter
- Original Articles
- The associations between mental health, health-related quality of life and insulin pump therapy among children and adolescents with type 1 diabetes
- Achieving target levels for vascular risk parameters in Polish school-age children with type 1 diabetes – a single center study
- Adipocyte aquaporin 7 (AQP7) expression in lean children and children with obesity. Possible involvement in molecular mechanisms of childhood obesity
- Use of complementary and alternative medicine in patients with inherited metabolic disease
- Are breast milk adipokines affected by maternal dietary factors?
- Comparison of serum 25-hydroxyvitamin D levels between radioimmunoassay and liquid chromatography-tandem mass spectrometry in infants and postpartum women
- Reference intervals for neonatal thyroid function tests in the first 7 days of life
- Treatment outcomes in pediatric differentiated thyroid carcinoma
- Seasonality of month of birth in children and adolescents with autoimmune thyroiditis: a continuing conundrum
- Follow-up in children with non-obese and non-autoimmune subclinical hypothyroidism
- Glucose intolerance in children with cystic fibrosis: a developing country’s perspective
- Letter to the Editor
- A patient with classical galactosemia is graduated with a university degree
- Case Reports
- Prepubertal gynaecomastia in a boy with Peutz-Jeghers syndrome: managing the aromatase overexpression
- Hypogammaglobulinemia and imaging features in a patient with infantile free sialic acid storage disease (ISSD) and a novel mutation in the SLC17A5 gene
- Xanthogranuloma of the sellar region accompanied by growth hormone deficiency: case report and literature review
- A case of Graves’ disease associated with membranoproliferative glomerulonephritis and leukocytoclastic vasculitis
