Timlin Homa, Liebowitz Jason E, Jaggi Khusleen, Geetha Duvuru
Department of Rheumatology, Johns Hopkins Bayview Medical Center, Baltimore, USA.
Department of Nephrology, Johns Hopkins Bayview Medical Center, Baltimore, USA.
Eur J Rheumatol. 2018 Mar;5(1):5-8. doi: 10.5152/eurjrheum.2017.17075. Epub 2017 Dec 7.
Hydralazine has been implicated as an etiologic agent for lupus-like syndrome and vasculitis. Hydralazine-induced vasculitis frequently affects the kidney, but the long-term renal outcomes in these patients have not yet been studied.
Patients who had a diagnosis of ANCA-associated vasculitis (AAV) and were on hydralazine at the time of AAV diagnosis were included in this retrospective cohort study. Clinical and laboratory data were obtained from the review of medical records.
Seven patients met the criteria for hydralazine-induced AAV. Five patients (71%) were African-American and four (57%) were female. The median age was 69 years at the time of diagnosis. All patients had renal involvement with two of them showing lung involvement as well. All patients had positive 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 immunosuppression and withdrawal of hydralazine. Three patients reached end-stage renal disease. The median follow-up time was 13 months.
Renal involvement in hydralazine-induced AAV was universal and can be associated with a poor renal outcome despite immunosuppressive therapy.
肼屈嗪被认为是狼疮样综合征和血管炎的病因。肼屈嗪诱导的血管炎常累及肾脏，但这些患者的长期肾脏结局尚未得到研究。
本回顾性队列研究纳入了诊断为抗中性粒细胞胞浆抗体相关性血管炎（AAV）且在AAV诊断时正在使用肼屈嗪的患者。通过查阅病历获取临床和实验室数据。
7例患者符合肼屈嗪诱导的AAV标准。5例患者（71%）为非裔美国人，4例（57%）为女性。诊断时的中位年龄为69岁。所有患者均有肾脏受累，其中2例也有肺部受累。所有患者MPO抗体均为阳性，1例患者PR3抗体为阳性。所有患者ANA均为阳性，7例患者中有3例抗组蛋白抗体为阳性。所有患者均接受免疫抑制治疗并停用肼屈嗪。3例患者进展至终末期肾病。中位随访时间为13个月。
肼屈嗪诱导的AAV中肾脏受累普遍存在，尽管进行了免疫抑制治疗，但仍可能与不良肾脏结局相关。
