Hydralazine-associated adverse events: a report of two cases of hydralazine-induced ANCA vasculitis

Zuckerman, Roman; Patel, Mayur; Costanzo, Eric; Dounis, Harry; Haj, Rany Al; Seyedali, Seyedehsara; Asif, Arif

doi:10.1590/2175-8239-jbn-3858

Cited by 18 publications

(19 citation statements)

References 29 publications

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“…The most important step in the management of this rare disease is discontinuation of the medication. If there is no improvement and or worsening of the renal indices, then treatment with plasmapheresis, cyclophosphamide, or rituximab should be considered [16]. Our patient was on hydralazine 100 mg every eight hours for more than five years, which could have increased the risk of AAV and DIL.…”

Section: Discussionmentioning

confidence: 98%

Hydralazine-Induced Dual Antineutrophil Cytoplasmic Antibody Positive Vasculitis and Nephritis

Padala¹,

Medepalli²,

Mohammed³

et al. 2020

Cureus

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Drug-induced autoimmunity occurs when exposure to a causative agent leads to serologic or clinical autoimmune responses. Syndromes that may be associated with drug-induced autoimmunity include antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) and drug-induced lupus (DIL). When drug-induced autoimmunity involves the kidney, histological patterns of injury include pauci-immune glomerulonephritis (GN), which occurs with AAV, and immune complex-mediated GN, which is associated with DIL. We present a case of hydralazine-induced dual ANCA-positive vasculitis and nephritis. Categories: Internal Medicine, Nephrology, Rheumatology Keywords: hydralazine, drug-induced lupus (dil), antineutrophil cytoplasmic antibody (anca), antineutrophil cytoplasmic antibody (anca) associated vasculitis (aav), pauci-immune glomerulonephritis (gn), acute kidney injury (aki), dual anca aav and dil, hydralazine induced dual aav and dil Open Access Case Report

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Section: Discussionmentioning

confidence: 98%

Hydralazine-Induced Dual Antineutrophil Cytoplasmic Antibody Positive Vasculitis and Nephritis

Padala¹,

Medepalli²,

Mohammed³

et al. 2020

Cureus

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“…So far, however, only 3 studies have reported hydralazine-induced vasculitis limited to the kidneys [ 3 – 5 ]. Only 1 study has reported on an asymptomatic patient with hydralazine-induced vasculitis [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…Plasmapheresis also was used on some patients. Hemodialysis is often applied when there is progression to end-stage kidney disease or if severe hyperkalemia develops [ 3 ]. However, progression of kidney disease can still vary, and it sometimes results in poor outcomes despite medical therapy [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…Antinuclear (ANA), anti-his-tone, anti-double-stranded DNA (dsDNA), and anti-cardiolipin antibodies also can be positive and present with serologic features that overlap with systemic lupus erythematosus (SLE) [ 2 ]. However, only 3 studies have described the kidneys as the only organs involved in hydralazine-induced ANCA vasculitis [ 3 – 5 ]. Thus, the purpose of the present case report is to illustrate an asymptomatic and kidney-limited presentation of hydralazine-induced ANCA-associated vasculitis, which can be easily missed, and to highlight the work-up leading to the diagnosis and discuss a current evidence-based approach to this disease.…”

Section: Introductionmentioning

confidence: 99%

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Hydralazine-Induced Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: Asymptomatic and Renal-Restricted Presentation

Fayman

Ward

et al. 2021

Am J Case Rep

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Patient: Female, 66-year-old Final Diagnosis: Hydralazine induced ANCA-associated vasculitis Symptoms: Asymptomatic Medication:— Clinical Procedure: — Specialty: Nephrology • Rheumatology Objective: Rare disease Background: Hydralazine, a potent vasodilator widely used to treat hypertension, has been implicated in an increasing number of cases of drug-induced autoimmune diseases in recent years. However, antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis secondary to hydralazine use has rarely been described and most reported cases involved multi-organ-related vasculitis, including skin and lung-kidney manifestations. ANCA-associated vasculitis is an immune-inflammatory condition characterized by necrotizing vasculitis with few or no immune deposits, predominantly affecting small vessels. The fact that the vasculitis is associated with hydralazine use and improves with discontinuation of hydralazine supports the diagnosis of hydralazine-induced disease. The case we report is a hydralazine-induced, ANCA-associated, pauci-immune crescentic glomerulonephritis with a presentation limited to the kidneys. Case Report: A 66-year-old woman was admitted to the hospital for worsening renal function over a month with no symptoms. Serology work-up was significantly positive for antinuclear, perinuclear ANCA, anti-histone, anti-double-stranded DNA, anti-cardiolipin, and anti-myeloperoxidase antibodies. The patient ultimately underwent a kidney biopsy, which revealed pauci-immune crescentic glomerulonephritis. Her kidney function improved with cessation of hydralazine as well as therapy with pulse steroids. Conclusions: Hydralazine is commonly prescribed to treat hypertension. Healthcare providers should be aware of potentially severe hydralazine-induced ANCA-associated vasculitis, which can present with various clinical manifestations. Serologic studies have indicated that it has features that overlap with lupus. Biopsy is helpful for making a definitive diagnosis and developing individual treatment plans. Early diagnosis, cessation of the offending drug, and initiation of immunosuppressive therapy are key for favorable prognosis.

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“…46 Previous studies have not shown the improvement effects of hydralazine on the histological changes. 47 Authors believe that the time of using hydralazine and also duration of treatment exert a very important role in pathological improvement.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic Effects of Hydralazine on Renal Ischemia-Reperfusion Injury in Rat.

2019

J. contemp. med. sci.

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Objective Renal ischemia-reperfusion (I-R) induces acute kidney injury (AKI). In this study, the effect of hydralazine was investigated on the renal injury induced by the I-R in rats. Methods AKI was induced with bilateral obstruction of the renal artery and vein for 20 min following 24 h of reperfusion. Hydralazine (5mg/ kg) was injected intraperitoneally as post-treatment. Results Hydralazine significantly increased the levels of renal clearance of creatinine and renal blood flow, while they were decreased by I-R. Also, hydralazine significantly improved levels of serum electrolytes (sodium and potassium) that were impaired by I-R. The tissue malondialdehyde levels were significantly suppressed by hydralazine. Conclusion According to the results, the post-treatment of hydralazine had a therapeutic effect on renal I-R because of improved ion reabsorption and excretion and increased renal blood flow and glomerular filtration rate and decreased lipid peroxidation. Key words hydralazine, renal ischemia-reperfusion injury, rat This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.

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Hydralazine-associated adverse events: a report of two cases of hydralazine-induced ANCA vasculitis

Cited by 18 publications

References 29 publications

Hydralazine-Induced Dual Antineutrophil Cytoplasmic Antibody Positive Vasculitis and Nephritis

Hydralazine-Induced Dual Antineutrophil Cytoplasmic Antibody Positive Vasculitis and Nephritis

Hydralazine-Induced Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: Asymptomatic and Renal-Restricted Presentation

Therapeutic Effects of Hydralazine on Renal Ischemia-Reperfusion Injury in Rat.

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