title: Hydralazine associated pauci-immune glomerulonephritis.
abstract: Hydralazine is a medication that has been used to manage hypertension and heart failure. In this case series, we report 4 patients who presented to a large, Midwestern academic medical center on chronic hydralazine therapy with acute kidney injury, nephritic urine sediment on urine microscopy, and the simultaneous presence of autoantibodies suggesting both drug-induced lupus and drug-induced vasculitis. All of them had evidence of pauci-immune glomerulonephritis on kidney biopsy. All the patients reported in our series are white women older than 60 years who were receiving hydralazine for more than 12 months at a dose of 150 mg or more. On initial presentation, all had evidence of acute kidney injury with nephritic sediment. These patients also had high titers of serum anti-neutrophil cytoplasmic antibodies of the antimyeloperoxidase subtype and simultaneous presence of multiple autoantibodies. All of them subsequently underwent a kidney biopsy, which revealed pauci-immune glomerulonephritis. This case series draws rheumatologists' attention to the possibility of pauci-immune glomerulonephritis in patients taking hydralazine, highlights the presence of multiple antibodies in these cases, and questions the long-term use of hydralazine especially in an elderly female population.
authors.affiliation: From the Divisions of *Nephrology and †Allergy/Rheumatology, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA.
authors.forename: Manish
authors.initials: M
authors.lastname: Suneja
authors.forename: Shalanki
authors.initials: S
authors.lastname: Baiswar
authors.forename: Scott A
authors.initials: SA
authors.lastname: Vogelgesang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017311:Amlodipine / Q000627:therapeutic use; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000139:chemically induced* / Q000175:diagnosis* / Q000473:pathology; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood; D000959:Antihypertensive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001706:Biopsy; D005260:Female; D005921:Glomerulonephritis / Q000139:chemically induced* / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D006830:Hydralazine / Q000009:adverse effects* / Q000627:therapeutic use; D006973:Hypertension / Q000188:drug therapy; D007668:Kidney / Q000473:pathology; D008875:Middle Aged; D016896:Treatment Outcome; D028761:Withholding Treatment
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D000959:Antihypertensive Agents; D017311:Amlodipine; D006830:Hydralazine