Ramadan Bashar, Taylor Jocelyn, Ahmed Moeed, Magliulo Eric K, Bashir Khalid
Internal Medicine, Creighton University School of Medicine, Omaha, USA.
Nephrology, Creighton University School of Medicine, Omaha, USA.
Cureus. 2021 Jun 24;13(6):e15906. doi: 10.7759/cureus.15906. eCollection 2021 Jun.
[Anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis] (AAV) is an autoimmune disease characterized by systemic vascular inflammation. We present a case of a 76-year-old man who presented with shortness of breath, fatigue, and weakness. He was eventually diagnosed with hydralazine-induced ANCA-associated renal limited glomerulonephritis. The presentation of this case was unique for a few reasons; the patient showed an initial improvement in kidney function, was non-oliguric, and had no systemic signs of vasculitis. This led to the patient being discharged prematurely with the diagnosis of acute tubular necrosis. We discuss educational features of this case and warn future clinicians about the possibility of waxing and waning renal function in these patients, as well as the importance of having a higher index of suspicion for glomerulonephritis in patients who take hydralazine.
抗中性粒细胞胞浆自身抗体（ANCA）相关性血管炎（AAV）是一种以系统性血管炎症为特征的自身免疫性疾病。我们报告一例76岁男性病例，该患者表现为呼吸急促、疲劳和虚弱。他最终被诊断为肼屈嗪诱导的ANCA相关性肾局限性肾小球肾炎。该病例的表现因几个原因而独特；患者肾功能最初有所改善，无少尿，且无血管炎的全身症状。这导致患者被误诊为急性肾小管坏死而过早出院。我们讨论了该病例的教学特点，并提醒未来的临床医生注意这些患者肾功能可能出现波动的情况，以及对服用肼屈嗪的患者高度怀疑肾小球肾炎的重要性。
