Membranous Nephropathy and Graves Disease: A Case Report and Literature Review

Objective: To describe a possible association between Graves' disease and nephrotic syndrome secondary to membranous nephropathy and to review the literature related to renal diseases in patients with Graves' disease. Methods:The clinical, laboratory, and renal biopsy findings in a patient with Graves' disease and membranous nephropathy are discussed.Results: 50 Y, Male, non diabetic, non hypertensive, diagnosed to have Grave's disease treated with antithyroid drugs, radioactive Iodine in recent past presented to us with edema since 2months, fever on/off since 2 months, and diarrhoea 20 days back.Investigations revealed nephrotic proteinuria, microscopic hematuria, normal serum creatinine, viral serology (HIV, HCV, HBsAg) were negative, ultrasound abdomen-showed normal sized kidneys, serum TSH was low (<0.05miu/ml),T3 was normal (1.74ng/ml), T4 was high (12.62mcg/dl),anti-microsomal (anti-thyroid-peroxidase) antibody was high (55 IU/ml), C3 was 74mg/dl, ANA, ANCA were negative, serum protein electrophoresis was normal.A renal biopsy showed membranous nephropathy (secondary).He was treated with steroids, diuretics, angiotensin converting enzyme inhibitors (ACEI), statins, and later, found to be in process of remission.But subsequently he lost for follow-up. Conclusions:To the best of our knowledge, this is one of few reports of the occurrence of membranous nephropathy in a patient with Graves' disease in the absence of any other immunologic disorder known to be associated.