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Journal of Pediatric Endocrinology and Metabolism

Editor-in-Chief: Kiess, Wieland

Ed. by Bereket, Abdullah / Darendeliler, Feyza / Dattani, Mehul / Gustafsson, Jan / Luo, Fei Hong / Mericq, Veronica / Toppari, Jorma


IMPACT FACTOR 2017: 1.086

CiteScore 2017: 1.07

SCImago Journal Rank (SJR) 2017: 0.465
Source Normalized Impact per Paper (SNIP) 2017: 0.580

Online
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2191-0251
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Volume 31, Issue 10

Issues

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

Werner Keenswijk
  • Corresponding author
  • Ghent University Hospital, Department of Pediatrics, Pediatric Nephrology, De Pintelaan 185, Ghent, Belgium
  • Ghent University, Department of Pediatrics and Medical Genetics, Ghent, Belgium
  • Diakonessenhuis, Department of Pediatrics, Paramaribo, Suriname, Phone: 003293323674, Fax: 003293322170
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Eva Degraeuwe / Anne Hoorens / Jo Van Dorpe / Johan Vande Walle
  • Ghent University, Department of Pediatrics and Medical Genetics, Ghent, Belgium
  • Ghent University Hospital, Department of Pediatrics, Pediatric Nephrology, Ghent, Belgium
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2018-09-18 | DOI: https://doi.org/10.1515/jpem-2018-0186

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.

Keywords: Graves’ disease; membranoproliferative glomerulonephritis; proteinuria

References

About the article

Corresponding author: Werner Keenswijk, MD, Ghent University Hospital, Department of Pediatrics, Pediatric Nephrology, De Pintelaan 185, Ghent, Belgium


Received: 2018-04-23

Accepted: 2018-07-30

Published Online: 2018-09-18

Published in Print: 2018-10-25


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.


Citation Information: Journal of Pediatric Endocrinology and Metabolism, Volume 31, Issue 10, Pages 1165–1168, ISSN (Online) 2191-0251, ISSN (Print) 0334-018X, DOI: https://doi.org/10.1515/jpem-2018-0186.

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