Hydralazine
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Hydralazine Lupus nephritis: case report
A 79-year-old man developed lupus nephritis during treatment with hydralazine for hypertension. The man was hospitalised for evaluation of nephritic syndrome and acute kidney injury with worsening proteinuria and haematuria in November 2016. He had a medical history of long-standing essential hypertension, stage 3 chronic kidney disease and diet-controlled type 2 diabetes. Three weeks prior to the presentation, for hypertension he was started on hydralazine25mg twice daily [route not stated] in October 2016. Rheumatology workup in 2015 for degenerative joint disease revealed positive antinuclear antibodies without specific antibodies for systemic lupus erythematosus. Thus, no connective tissue disease was found. At the current presentation, urological examination for haematuria and CT urogram exhibited no stones or blockages. Laboratory tests showed nephrotic-range proteinuria, haematuria and elevated level of serum creatinine. He exhibited features of drug-induced lupus nephritis with highly positive anti-dsDNA antibody and positive antihistone antibody. Perinuclear cytoplasmic antineutrophil cytoplasmic antibody, glomerular basement membrane antibodies and cytoplasmic antineutrophil cytoplasmic antibody were found to be negative. The man was advised to discontinue hydralazine. Despite discontinuation (in November 2016), his renal function did not improve. Also, serum creatinine and glomerular filtration rate were found to be abnormal. Kidney biopsy showed diffuse proliferative glomerulonephritis. Based on these findings, a diagnosis of hydralazine-induced lupus nephritis was confirmed. Subsequently, he received immunosuppressive therapy with methylprednisolone followed by mycophenolate mofetil and prednisone. Upon discontinuation of mycophenolate mofetil, he developed pneumonia and shingles. He was continued on a tapered dose of prednisone for 3 months, followed by prednisone 10mg for additional 4 months. His renal function progressively improved. His lupus nephritis and proteinuria resolved after 7 months of immunosuppressive therapy and all immunologic markers returned to the baseline. Khan N, et al. Hydralazine-induced isolated lupus nephritis. Ochsner Journal 20: 187-192, No. 2, Jun 2020. Available from: URL: http://doi.org/10.31486/ toj.18.0128
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Reactions 29 Aug 2020 No. 1819
