Anti-neutrophil Cytoplasmic Antibody-Associated Glomerulonephritis Secondary to Hydralazine: A Case Report

Abstract

Hydralazine is a vasodilator used in the treatment of resistant hypertension. It is a safe and widely used antihypertensive medicine. Its common adverse effects include headache, rebound tachycardia, fluid retention, and angina. It is a rare cause of anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) with pulmonary and renal involvement. We report a case of a 74-year-old woman, with over eight years of use of hydralazine, who presented to the hospital with shortness of breath and cough. Blood work revealed deranged renal function with high creatinine levels. Serology workup was positive for antihistone antibodies (AHA), anti-nuclear antibodies (ANA), myeloperoxidase (MPO) ANCA and proteinase-3 (PR-3) ANCA. Renal biopsy showed diffusely flattened tubular epithelium, focal micro vesicular degeneration, and focal loss of the brush border of the proximal tubular epithelium. Hydralazine was stopped and the patient was treated with corticosteroids, resulting in the resolution of her kidney injury.

Hydralazine-Induced Antineutrophilic Cytoplasmic Antibody (ANCA)-Associated Vasculitis Presenting as Crescentic Glomerulonephritis

“…Although the precise mechanism is unknown, it is believed to involve the drug triggering the formation of ANCA, which damages small blood vessels in different organs. Additionally, there is an increase in drug-induced AAV in females, those older than 60, and people who suffer from diabetes, heart failure, or pre-existing renal disease [ 1 , 5 ]. Even though the most likely diagnosis in this case was hydralazine-induced AAV with CrGN, it is crucial to take additional differential diagnoses into account to guarantee an accurate diagnosis and course of therapy.…”

“…Hydralazine, a vasodilator used in the treatment of hypertension, is a rare cause of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) with pulmonary and renal involvement [ 1 ]. AAV is a pauci-immune inflammatory condition characterized by small vessel necrotizing vasculitis [ 2 ].…”