Incidence and Risk Factors of Hydralazine Associated ANCA Associated Glomerulonephritis
Hydralazine Associated ANCA Associated Glomerulonephritis
Keywords:
anti-neutrophilic cytoplasmic antibody (ANCA), 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), has an incidence of 5.4% in patients receiving 100 mg/day to 10.4% in patients receiving 200 mg/day for more than 3 years. In Thailand, there have been no reported incidence of ANCA-related vasculitis associated with hydralazine. This prospective study aimed to assess the incidence and risk factors of AAV for associated with hydralazine in total 345 hydralazine used patients. The median dose of hydralazine used was 150 mg/day, and the median duration of treatment was 20 months. The AAV group had a higher dosage of hydralazine use than the group that did not develop AAV. A possible predictor of AAV was hydralazine dose-dependent. Hydralazine more than 100 mg/day increased the risk of AAV by 2.64-fold (95%CI = 1.16-6.95). If homogenous antinuclear antibodies (ANA) were present, the risk increased by 9.09-fold (95%CI = 3.09- 26.45), CRP more than 5 mg/L the risk increased by 13.78-fold (95%CI = 1.80-29.08) and low complement 3 level increased the risk by 10.4-fold (95%CI =3.94-25.93). The incidence of AAV with hydralazine use was 6.7%. Risk factors for disease development were the dose of hydralazine. Possible predictors of AAV included the presence of homogenous type of ANA, CRP greater than 5 mg/L, elevated creatinine, and low complement 3 levels
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