Hydralazine associated pauci-immune glomerulonephritis

Area of Science:

• Nephrology
• Rheumatology
• Internal Medicine

Background:

• Hydralazine is a vasodilator commonly prescribed for hypertension and heart failure.
• Chronic use may be associated with various adverse effects.
• Drug-induced autoimmune syndromes are a recognized complication of certain medications.

Observation:

• A case series of four elderly white women on chronic hydralazine therapy (≥150 mg/day for >12 months) presented with acute kidney injury.
• Patients exhibited nephritic urine sediment and high titers of anti-neutrophil cytoplasmic antibodies (ANCA), specifically antimyeloperoxidase subtype.
• Simultaneous presence of multiple autoantibodies suggested concurrent drug-induced lupus and vasculitis.

Findings:

• Kidney biopsies revealed pauci-immune glomerulonephritis in all four patients.
• The clinical presentation and serological findings were consistent with hydralazine-induced autoimmune disease.
• The patients were all women over 60 years old, suggesting a potential demographic predisposition.

Implications:

• This case series highlights pauci-immune glomerulonephritis as a potential renal complication of long-term hydralazine use.
• It emphasizes the importance of considering hydralazine in the differential diagnosis of autoimmune glomerulonephritis, especially in elderly women.
• The findings question the safety of long-term, high-dose hydralazine therapy in this population and warrant further investigation.