Hydralazine Associated Pauci-Immune Glomerulonephritis

Suneja, Manish; Baiswar, Shalanki; Vogelgesang, Scott A.

doi:10.1097/rhu.0000000000000049

Cited by 13 publications

(7 citation statements)

References 13 publications

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“…The renal outcomes in patients with hydralazine induced vasculitis have been variable. For example, one series of four patients on chronic hydralazine who developed pauci-immune glomerulonephritis reported that the creatinine for all patients return to baseline or close to baseline within 6 months of follow-up (17). In contrast, in a case series of 17 patients with suspected hydralazine-induced nephritis in which minimum follow-up was 6 months, five patients required dialysis within 2 weeks to 6 years of stopping hydralazine and one patient died of uremia (18).…”

Section: Discussionmentioning

confidence: 95%

Outcomes of hydralazine induced renal vasculitis

Timlin¹,

Liebowìtz²,

Jaggi³

et al. 2018

Eur J Rheumatol

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Section: Discussionmentioning

confidence: 95%

Outcomes of hydralazine induced renal vasculitis

Timlin¹,

Liebowìtz²,

Jaggi³

et al. 2018

Eur J Rheumatol

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“…It was also reported that hydralazine-induced vasculitis is more common in slow acetylators since hydralazine acetylation will be slower and that gives more chance for a break in tolerance [10]. The risk for developing hydralazine-induced ANCA-associated vasculitis increases with longer duration and higher doses of hydralazine therapy especially in slow acetylators, female patients, and patients with history of thyroid disease [11,12].…”

Section: Discussionmentioning

confidence: 99%

“…Renal outcomes for this condition in published cases have been variable, with one case series reporting full recovery in all patients [11] and others reporting around one third to half of patients requiring long-term hemodialysis despite immunosuppressive therapy [15,16].…”

Section: Discussionmentioning

confidence: 99%

Hydralazine-induced antineutrophil cytoplasmic antibody-associated vasculitis with pulmonary–renal syndrome: a case report

et al. 2020

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Background: Hydralazine is a common vasodilator which has been used for the treatment of hypertension and heart failure. Hydralazine can induce antineutrophil cytoplasmic antibody-associated vasculitis due to its autoimmunogenic capability and one of the very rare presentations is pulmonary-renal syndrome. Case presentation: We report a case of a 64-year-old African American woman, who presented to our emergency room with shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, leg swelling, fatigue, loss of appetite, cough with clear sputum, and lightheadedness. On admission, she developed acute hypoxic respiratory failure requiring intubation and acute renal failure requiring hemodialysis. A serologic workup was positive for antineutrophil cytoplasmic antibody, antinuclear antibody, anti-histone, anti-cardiolipin IgM, and anti-doublestranded DNA antibodies. A renal biopsy was done due to persistent deterioration in kidney function and demonstrated classic crescentic (pauci-immune) glomerulonephritis. Hydralazine was empirically discontinued early in the admission and she was started on corticosteroids and cyclophosphamide following biopsy results. She was clinically stable but remained dependent on hemodialysis after discharge. Conclusion: Hydralazine-induced antineutrophil cytoplasmic antibody-associated vasculitis with pulmonary-renal syndrome is a rare occurrence. In the setting of hydralazine use, multiple positive antigens, and multisystem involvement, clinicians should consider this rare condition requiring prompt cessation of offending drug, early evaluation with biopsy, and contemplate empiric immunosuppressive therapy while biopsy confirmation is pending.

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“…The incidence rate can be up to 10.4% in patients taking a dose of 200 mg/day for greater than three years [8]. Serum complement levels can be beneficial in differentiating the underlying pathogenesis since C3 and C4 levels are usually normal in PIGN and anti-GBM disease as opposed to the low levels seen in another glomerulonephritis [9,10]. The serological studies may also cause confusion like in our case.…”

Section: Discussionmentioning

confidence: 72%

Not Lupus Nephritis but a Rare Case of Drug-Induced Pauci-Immune Glomerulonephritis

Hang¹,

Dixit²,

Fatima³

et al. 2022

Cureus

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Hydralazine-induced pauci-immune glomerulonephritis is a rare cause of glomerulonephritis. It is an antineutrophil cytoplasmic antibody (ANCA) associated vasculitis that can be rapidly progressive and potentially life-threatening. However, most cases are found to be asymptomatic, and patients often present with acute renal failure and painless hematuria. It has been confused with lupus nephritis but treatment differs, thus, necessitating the need for differentiation.A case report of an 80-year-old African American woman with a history of hypertension, diabetes mellitus type 2, and hypothyroidism, who presented with generalized weakness and weight loss of 30-40 lbs. The patient had been treated with hydralazine for months for hypertension. She presented to the hospital with acute renal failure that worsened over the course of several months eventually requiring hemodialysis.The patient was found to have drug-induced ANCA vasculitis from hydralazine. This etiology was confirmed with pauci-immune glomerulonephritis seen on renal biopsy. This presentation has the potential of being confused with lupus nephritis. Despite the initial serology being suggestive of lupus, this type of nephritis does not have positive immunofluorescence.The treatment of nephritis in this patient was generally supportive. However, it was important to identify the underlying cause of renal failure. Equally important to initiating immunosuppressive therapy, it was imperative to discontinue the offending drug in a timely manner to prevent rapid organ failure. The causative agent, hydralazine, may have otherwise gone unnoticed without a thorough investigation into other causes of renal failure. Thus, it is important to consider this as a diagnosis with a patient who presents with rapidly progressive renal failure on hydralazine and may mimic lupus nephritis.

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Hydralazine Associated Pauci-Immune Glomerulonephritis

Cited by 13 publications

References 13 publications

Outcomes of hydralazine induced renal vasculitis

Outcomes of hydralazine induced renal vasculitis

Hydralazine-induced antineutrophil cytoplasmic antibody-associated vasculitis with pulmonary–renal syndrome: a case report

Not Lupus Nephritis but a Rare Case of Drug-Induced Pauci-Immune Glomerulonephritis

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