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Hydralazine-associated glomerulonephritis.

S Björck, C Svalander, G Westberg

    Acta Medica Scandinavica
    |January 1, 1985
    PubMed
    Summary
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    Hydralazine therapy can cause rapidly progressive glomerulonephritis, a kidney disease. Stopping hydralazine early improves kidney function, while continuing it leads to permanent renal insufficiency.

    Area of Science:

    • Nephrology
    • Rheumatology
    • Clinical Pharmacology

    Background:

    • Hydralazine is a vasodilator used to treat hypertension.
    • Drug-induced lupus erythematosus is a known side effect of hydralazine.
    • Rapidly progressive glomerulonephritis (RPGN) is a severe kidney disease characterized by rapid loss of kidney function.

    Purpose of the Study:

    • To investigate the association between hydralazine therapy and rapidly progressive glomerulonephritis.
    • To describe the clinical, serological, and histological features of hydralazine-induced RPGN.
    • To evaluate the outcome of hydralazine cessation in patients with RPGN.

    Main Methods:

    • Retrospective case series of nine patients who developed RPGN during hydralazine therapy.
    • Clinical data collection including symptoms, laboratory tests (antinuclear antibody, anti-histone antibodies, ESR), and drug acetylation status.

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  • Renal biopsy analysis using light microscopy, immunofluorescence, and electron microscopy.
  • Assessment of treatment outcomes based on hydralazine cessation or continuation.

    • Main Results:

    • All nine patients developed RPGN while on hydralazine; seven improved after drug cessation.
    • Most patients lacked systemic symptoms typical of hydralazine-induced lupus.
    • Positive antinuclear antibody tests were universal; anti-histone antibodies were present in six patients.
    • Renal biopsies showed segmental glomerular necrosis and extracapillary proliferation.
    • Deposits in glomerular capillary walls were observed in five of seven examined specimens.

    Conclusions:

    • Rapidly progressive glomerulonephritis can be a late, monosymptomatic manifestation of hydralazine therapy.
    • Early cessation of hydralazine is crucial for improving renal outcomes.
    • Hydralazine-induced RPGN should be considered in patients presenting with unexplained glomerulonephritis, even without systemic symptoms.