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  • Review Article
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Propylthiouracil-induced antineutrophil cytoplasmic antibody-associated vasculitis

Nature Reviews Nephrology volume 8, pages 476–483 (2012)Cite this article

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Abstract

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) refers to a group of potentially life-threatening autoimmune diseases. A recent development in this field is the recognition that certain drugs can induce AAV. Among these agents, the drug most often implicated in causing disease is the commonly used antithyroid agent propylthiouracil (PTU). This Review provides an update on PTU-induced AAV. Clinical characteristics of PTU-induced AAV are similar to that of primary AAV, but usually have a milder course and better prognosis, provided early cessation of the disease-causing drug. PTU-induced ANCAs usually react to several components of myeloid granules, which is helpful in differentiating PTU-induced AAV from primary AAV. Early cessation of PTU is crucial in the treatment of PTU-induced AAV. The duration of immunosuppressive therapy might be shorter than in primary AAV, depending on the severity of organ damage, and maintenance therapy is not always necessary.

Key Points

  • The antithyroid drug propylthiouracil (PTU) can induce antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis

  • The interaction between PTU and myeloperoxidase might contribute to the pathogenesis of PTU-induced vasculitis

  • PTU-induced ANCAs usually react to several components of myeloid granules

  • Compared with primary ANCA-associated vasculitis, PTU-induced vasculitis usually has a mild course and good prognosis, provided early cessation of the disease-causing drug

  • The duration of immunosuppressive therapy for PTU-induced vasculitis might be shorter than in primary ANCA-associated vasculitis, depending on the severity of organ damage, and maintenance therapy might not be necessary

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Acknowledgements

Our studies discussed in this Review were supported by a grant from the Chinese 973 project (No. 2012CB517702) and two grants from the National Natural Science Fund (No. 30972733 and No. 81021004).

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  1. Renal Division, Department of Medicine, 8 Xishiku Street, Xicheng District, 100034, Beijing, China

    Min Chen & Ming-Hui Zhao

  2. Department of Endocrinology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, 100034, Beijing, China

    Ying Gao & Xiao-Hui Guo

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M. Chen and Y. Gao researched data to include in the article and made a substantial contribution to discussion of content for the article. M. Chen and M.-H. Zhao wrote the article. M. Chen, X.-H. Guo and M.-H. Zhao reviewed and edited the manuscript before submission.

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Correspondence to Ming-Hui Zhao.

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Chen, M., Gao, Y., Guo, XH. et al. Propylthiouracil-induced antineutrophil cytoplasmic antibody-associated vasculitis. Nat Rev Nephrol 8, 476–483 (2012). https://doi.org/10.1038/nrneph.2012.108

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