Hydralazine associated pauci-immune glomerulonephritis

Manish Suneja; Shalanki Baiswar; Scott A Vogelgesang

doi:10.1097/RHU.0000000000000049

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Hydralazine associated pauci-immune glomerulonephritis

Journal article

Peer reviewed

Hydralazine associated pauci-immune glomerulonephritis

Manish Suneja, Shalanki Baiswar and Scott A Vogelgesang

Journal of clinical rheumatology, Vol.20(2), pp.99-102

03/2014

DOI: 10.1097/RHU.0000000000000049

PMID: 24561415

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Abstract

Hydralazine is a medication that has been used to manage hypertension and heart failure. In this case series, we report 4 patients who presented to a large, Midwestern academic medical center on chronic hydralazine therapy with acute kidney injury, nephritic urine sediment on urine microscopy, and the simultaneous presence of autoantibodies suggesting both drug-induced lupus and drug-induced vasculitis. All of them had evidence of pauci-immune glomerulonephritis on kidney biopsy. All the patients reported in our series are white women older than 60 years who were receiving hydralazine for more than 12 months at a dose of 150 mg or more. On initial presentation, all had evidence of acute kidney injury with nephritic sediment. These patients also had high titers of serum anti-neutrophil cytoplasmic antibodies of the antimyeloperoxidase subtype and simultaneous presence of multiple autoantibodies. All of them subsequently underwent a kidney biopsy, which revealed pauci-immune glomerulonephritis. This case series draws rheumatologists' attention to the possibility of pauci-immune glomerulonephritis in patients taking hydralazine, highlights the presence of multiple antibodies in these cases, and questions the long-term use of hydralazine especially in an elderly female population.

Glomerulonephritis - chemically induced

Kidney - pathology

Humans

Middle Aged

Glomerulonephritis - diagnosis

Hypertension - drug therapy

Treatment Outcome

Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - pathology

Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - chemically induced

Antihypertensive Agents - therapeutic use

Withholding Treatment

Amlodipine - therapeutic use

Antihypertensive Agents - adverse effects

Hydralazine - adverse effects

Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - diagnosis

Hydralazine - therapeutic use

Biopsy

Glomerulonephritis - pathology

Aged, 80 and over

Female

Aged

Antibodies, Antineutrophil Cytoplasmic - blood

Details

Title: Subtitle: Hydralazine associated pauci-immune glomerulonephritis
Creators: Manish Suneja - From the Divisions of Nephrology and †Allergy/Rheumatology, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA
Shalanki Baiswar
Scott A Vogelgesang
Resource Type: Journal article
Publication Details: Journal of clinical rheumatology, Vol.20(2), pp.99-102
DOI: 10.1097/RHU.0000000000000049
PMID: 24561415
ISSN: 1076-1608
eISSN: 1536-7355
Language: English
Date published: 03/2014
Academic Unit: Nephrology; Immunology; Internal Medicine; Ophthalmology and Visual Sciences
Record Identifier: 9984094361902771

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