The Proportion and Clinical Differences of Hydralazine Associated ANCA Associated Vasculitis Compare to Primary ANCA Associated Vasculitis
Hydralazine Associated ANCA Associated Vasculitis
Keywords:
anti-neutrophilic cytoplasmic antibody (ANCA), primary ANCA-associated vasculitis (AAV), hydralazine-associated ANCA-associated vasculitis (hydralazine-AAV)Abstract
Hydralazine, known as drug, induced anti-neutrophilic cytoplasmic antibody (ANCA) associated vasculitis (AAV), is a vasodilator used as an adjunct drug for the treatment of moderate to severe hypertension and heart failure with a reduced ejection fraction. AAV is a rare phenomenon, that causes severe pulmonary and nephritis syndrome. This retrospective study was conducted to compare the proportion and differences of AAV in patients taking hydralazine compared to primary ANCA-associated vasculitis, 75 cases of AAV were found, 38 cases were hydralazine-AAV, accounting for 50.67% of AAV. The presence of red blood cells in the urine, diffuse alveolar hemorrhage, inflammation of the lungs and respiratory failure were no difference between the two groups. Treatment was not difference between both groups, with plasma exchange, intravenous pulse methylprednisolone, cyclophosphamide, dialysis from the beginning, and the need for long-term dialysis, was up to more than 30% in both groups. The mortality rate was very high in both groups. In conclusion, hydralazine causes more than half of all ANCA-associated vasculitis cases. Clinical manifestation, laboratory, serologic studies, treatment, the need for long-term dialysis and mortality are not different in both groups.
References
Doughem K, Battisha A, Sheikh O, Konduru L, Madoukh B, Mohammed B, et al. Hydralazine-induced ANCA associated vasculitis (AAV) presenting with pulmonary-renal syndrome (PRS): A case report with literature review. Curr Cardiol Rev 2021;17(2):182-7.
Nasr SH, D'Agati VD, Park HR, Sterman PL, Goyzueta JD, Dressler RM, et al. Necrotizing and crescentic lupus nephritis with antineutrophil cytoplasmic antibody seropositivity. Clin J Am Soc Nephrol 2008;3(3):682-90.
Gandhi P, Khurana B, Munjal RS, Sekar A, Gandhi RG. Hydralazine-induced vasculitis. Cureus 2023;15(2):e35306. doi: 10.7759/cureus.35306
Mulkareddy V, Bhalla V, Mangla A. Hydralazine-induced ANCA-associated vasculitis: A rare cause of diffuse alveolar hemorrhage. Chest 2020:157(6 Suppl):A364. doi.org/10.1016/j.chest.2020.05.408
Scheuing W, Kumar N, Davis W, Quinet R. Case report: Hydralazine‐induced ANCA‐associated vasculitis. The Rheumatologist 2021 [updated 2021 Feb 16]. Available from: http://www.the‐rheumatologist.org/article/case‐report‐hydralazine‐induced‐anca‐associated‐vasculitis
Tu W, Fayman B, Ward SC, Mamoon Y, Bandagi SS. Hydralazine-induced antineutrophil cytoplasmic antibody-associated vasculitis: Asymptomatic and renal-restricted presentation. Am J Case Rep 2021;22:e931263. doi: 10.12659/AJCR.931263
Zuckerman R, Patel M, Costanzo EJ, Dounis H, Haj RA, Seyedali S, et al. Hydralazine-associated adverse events: A report of two cases of hydralazine-induced ANCA vasculitis. J Bras Nefrol 2018;40(2):193-7.
Al-Abdouh A, Siyal AM, Seid H, Bekele A, Garcia P. Hydralazine-induced antineutrophil cytoplasmic antibody-associated vasculitis with pulmonary-renal syndrome: A case report. J Med Case Rep 2020;14(1):47. doi: 10.1186/s13256-020-02378-w
Aeddula NR, Pathireddy S, Ansari A, Juran PJ. Hydralazine-associated antineutrophil cytoplasmic antibody vasculitis with pulmonary-renal syndrome. BMJ Case Rep 2018;(2018):bcr2018227161. doi: 10.1136/bcr-2018-227161.
Hogan JJ, Markowitz GS, Radhakrishnan J. Drug-induced glomerular disease: Immune-mediated injury. Clin J Am Soc Nephrol 2015;10(7):1300-10.
Pendergraft WF 3rd, Niles JL. Trojan horses: Drug culprits associated with antineutrophil cytoplasmic autoantibody (ANCA) vasculitis. Curr Opin Rheumatol 2014;26(1):42-9.
Hess E. Drug-related lupus. N Engl J Med 1988;318(22):1460-2.
Yokogawa N, Vivino FB. Hydralazine-induced autoimmune disease: comparison to idiopathic lupus and ANCA-positive vasculitis. Mod Rheumatol 2009;19(3):338-47.
Kumar B, Strouse J, Swee M, Lenert P, Suneja M. Hydralazine-associated vasculitis: Overlapping features of drug-induced lupus and vasculitis. Semin Arthritis Rheum 2018;48(2):283-7.
Choi HK, Merkel PA, Walker AM, Niles JL. Drug-associated antineutrophil cytoplasmic antibody-positive vasculitis: Prevalence among patients with high titers of antimyeloperoxidase antibodies. Arthritis Rheum 2000;43(2):405-13.
Yokogawa N, Vivino FB. Hydralazine-induced autoimmune disease: Comparison to idiopathic lupus and ANCA-positive vasculitis. Mod Rheumatol 2009;19(3):338-47.
Suppiah R, Robson JC, Grayson PC, Ponte C, Craven A, Khalid S, et al. 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology Classification Criteria for Microscopic Polyangiitis. Arthritis Rheumatol 2022;74(3):400-6.
Almaani S, Fussner LA, Brodsky S, Meara AS, Jayne D. ANCA-associated vasculitis: An update. J Clin Med 2021;10(7):1446. doi: 10.3390/jcm10071446
Ntatsaki E, Watts RA, Scott DG. Epidemiology of ANCA-associated vasculitis. Rheum Dis Clin North Am 2010;36(3):447-61.
Zuckerman R, Patel M, Costanzo EJ, Dounis H, Haj RA, Seyedali S, et al. Hydralazine-associated adverse events: A report of two cases of hydralazine-induced ANCA vasculitis. J Bras Nefrol 2018;40(2):193-7.
Doughem K, Battisha A, Sheikh O, Konduru L, Madoukh B, Al-Sadawi M, et al. Hydralazine-induced ANCA associated vasculitis (AAV) presenting with pulmonary-renal syndrome (PRS): A case report with literature review. Curr Cardiol Rev 2021;17(2):182-7.
McKinnon RA, Nebert DW. Possible role of cytochromes P450 in lupus erythematosus and related disorders. Lupus 1994;3(6):473-8.
Santoriello D, Bomback AS, Kudose S, Batal I, Stokes MB, Canetta PA, et al. Anti-neutrophil cytoplasmic antibody associated glomerulonephritis complicating treatment with hydralazine. Kidney Int 2021;100(2):440-6.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Buddhchinaraj Phisanulok Hospital
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
