Outcomes of hydralazine induced renal vasculitis

Abstract

Objective: Hydralazine has been implicated as an etiologic agent for lupus-like syndrome and vasculi-tis. Hydralazine-induced vasculitis frequently affects the kidney, but the long-term renal outcomes inthese patients have not yet been studied.Methods: Patients who had a diagnosis of ANCA-associated vasculitis (AAV) and were on hydralazineat the time of AAV diagnosis were included in this retrospective cohort study. Clinical and laboratorydata were obtained from the review of medical records.Results: Seven patients met the criteria for hydralazine-induced AAV. Five patients (71%) were Afri-can-American and four (57%) were female. The median age was 69 years at the time of diagnosis. Allpatients had renal involvement with two of them showing lung involvement as well. All patients hadpositive MPO antibody and one patient had positive PR3 antibody. ANA was positive in all patients,and three of seven patients had positive anti-histone antibody. All of them were treated with immu-nosuppression and withdrawal of hydralazine. Three patients reached end-stage renal disease. Themedian follow-up time was 13 months.Conclusion: Renal involvement in hydralazine-induced AAV was universal and can be associated witha poor renal outcome despite immunosuppressive therapy.