Hydralazine-induced ANCA-positive pauci-immune glomerulonephritis: a case report and literature review.

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  • Author(s): Dobre M;Dobre M; Wish J; Negrea L
  • Source:
    Renal failure [Ren Fail] 2009; Vol. 31 (8), pp. 745-8.
  • Publication Type:
    Journal Article
  • Language:
    English
  • Additional Information
    • Source:
      Publisher: Informa Healthcare Country of Publication: England NLM ID: 8701128 Publication Model: Print Cited Medium: Internet ISSN: 1525-6049 (Electronic) Linking ISSN: 0886022X NLM ISO Abbreviation: Ren Fail Subsets: MEDLINE
    • Publication Information:
      Publication: London : Informa Healthcare
      Original Publication: New York, N.Y. : M. Dekker, c1987-
    • Subject Terms:
      Antibodies, Antineutrophil Cytoplasmic/*immunology ; Antihypertensive Agents/*adverse effects ; Glomerulonephritis/*chemically induced ; Glomerulonephritis/*immunology ; Hydralazine/*adverse effects ; Hypertension/*drug therapy; Female ; Humans
    • Abstract:
      We report a case of hydralazine-induced alveolar hemorrhage and anti-neutrophil cytoplasmic antibody (ANCA)-positive pauci-immune glomerulonephritis, with serum anti-histone antibodies present, features not previously described in the literature with this drug. A 50-year-old Caucasian female had hypertension treated with hydralazine 75mg TID for three years, and a lung nodule followed up periodically with chest-computed tomographies. She was admitted to the hospital for hemoptysis and newly discovered diffuse pulmonary ground-glass opacities. Transbronchial lung biopsy showed alveolar hemorrhage. Serum creatinine was 3.5 mg/dL and urinalysis showed 2+blood, 30-50RBC/hpf and red blood cell casts. ANCA against myeloperoxidase were present. Anti-double-stranded DNA, ANA, and anti-histone antibodies were positive. Serum complements were normal. Renal biopsy revealed focal crescentic necrotizing glomerulonephritis with negative immunofluorescence, consistent with pauci-immune ANCA-positive vasculitis. Serum creatinine returned to baseline three days after hydralazine was discontinued, and the hemoptysis resolved after treatment with cyclophosphamide and prednisone was started. We concluded that this case represents a hydralazine-induced small vessel vasculitis rather than an idiopathic one. The possibility of hydralazine-induced vasculitis should be considered when patients treated with hydralazine develop a pulmonary-renal syndrome. Anti-histone antibodies may be present in the absence of full classification criteria of drug-induced lupus.
    • Accession Number:
      0 (Antibodies, Antineutrophil Cytoplasmic)
      0 (Antihypertensive Agents)
      26NAK24LS8 (Hydralazine)
    • Publication Date:
      Date Created: 20091010 Date Completed: 20100105 Latest Revision: 20131121
    • Publication Date:
      20231215
    • Accession Number:
      10.3109/08860220903118590
    • Accession Number:
      19814644