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Membranous Nephropathy With Crescents in a Patient With Hashimoto’s Thyroiditis: A Case Report
- Source :
- Medicine
- Publication Year :
- 2014
- Publisher :
- Wolters Kluwer Health, 2014.
-
Abstract
- Membranous nephropathy is a common cause of nephrotic syndrome in adults. It usually occurs secondary to underlying disease processes such as autoimmune disorders, malignancy, infection, and drugs. The presentation of nephrotic syndrome with concomitant precipitous decline in renal function warrants investigation of a coexistent disorder. We report the case of a 30-year-old male who presented with symptoms and signs of hypothyroidism. A diagnosis of Hashimoto’s thyroiditis was contemplated based on the presence of high serum levels of antithyroglobulin and antithyroid peroxidase antibodies. Upon initiation of treatment with levothyroxine, patient symptomatology improved; however, the laboratory studies demonstrated continued elevated creatinine, hematuria, and proteinuria, which had not been addressed. Two months following treatment initiation, he had progressive deterioration in renal function and proteinuria. A renal biopsy revealed coexistent necrotizing and crescentic glomerulonephritis and membranous nephropathy. The final diagnosis was necrotizing, crescentic glomerulonephritis with superimposed membranous nephropathy likely secondary to Hashimoto’s thyrodiitis. Induction treatment with oral cyclophosphamide and prednisone was started. At the end of 6 months of treatment, there was improvement in renal function and proteinuria and maintenance treatment with azathioprine and low-dose prednisone was initiated. This case highlights the importance of precise and detailed evaluation of patients with autoimmune diseases such as Hashimoto’s thyroiditis particularly in the presence of active urine sediment. Proper evaluation and diagnosis of such patients has implications on the prognosis and response to treatment.
- Subjects :
- Adult
Male
medicine.medical_specialty
Prednisolone
Hashimoto Disease
urologic and male genital diseases
Gastroenterology
Glomerulonephritis, Membranous
Thyroiditis
Article
Glomerulonephritis
Membranous nephropathy
Prednisone
Internal medicine
Azathioprine
medicine
Humans
Cyclophosphamide
Proteinuria
business.industry
General Medicine
medicine.disease
Thyroxine
Immunology
medicine.symptom
business
Nephrotic syndrome
medicine.drug
Subjects
Details
- Language :
- English
- ISSN :
- 15365964 and 00257974
- Volume :
- 93
- Issue :
- 8
- Database :
- OpenAIRE
- Journal :
- Medicine
- Accession number :
- edsair.doi.dedup.....5ef5aa109e71161fc7877603615b7f77