P-ANCA positive renal vasculitis in association with renal cell carcinoma and prolonged hydralazine therapy.
Renal cell carcinoma and hydralazine drug therapy has each been reported as rare associations with pauci-immune renal vasculitis. We report a patient in whom both factors were operative simultaneously. A middle-aged man on long term hydralazine therapy presented with advanced renal failure. Serum was strongly positive for P-ANCA with high anti-myeloperoxidase (MPO) titre and renal biopsy showed focal necrotizing glomerulonephritis. A renal mass was identified on scanning and at left nephrectomy a large renal cell carcinoma was removed. In spite of an apparently curative operation and discontinuation of hydralazine, P-ANCA remains strongly positive, he has had no recovery of renal function and has progressed to dialysis dependence.
St. Luke's Hospital, West Yorkshire, UK.
Jonathan H
JH
Norris
John
J
Leeds
Robin F
RF
Jeffrey
D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood*; D000959:Antihypertensive Agents / Q000009:adverse effects*; D002292:Carcinoma, Renal Cell / Q000097:blood* / Q000150:complications* / Q000628:therapy; D006801:Humans; D006830:Hydralazine / Q000009:adverse effects*; D007674:Kidney Diseases / Q000097:blood* / Q000209:etiology* / Q000628:therapy; D007680:Kidney Neoplasms / Q000097:blood* / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014657:Vasculitis / Q000097:blood* / Q000209:etiology* / Q000628:therapy
D019268:Antibodies, Antineutrophil Cytoplasmic; D000959:Antihypertensive Agents; D006830:Hydralazine