P-ANCA Positive Renal Vasculitis in Association with Renal Cell Carcinoma and Prolonged Hydralazine Therapy

Abstract

Renal cell carcinoma and hydralazine drug therapy has each been reported as rare associations with pauci-immune renal vasculitis. We report a patient in whom both factors were operative simultaneously. A middle-aged man on long term hydralazine therapy presented with advanced renal failure. Serum was strongly positive for P-ANCA with high anti-myeloperoxidase (MPO) titre and renal biopsy showed focal necrotizing glomerulonephritis. A renal mass was identified on scanning and at left nephrectomy a large renal cell carcinoma was removed. In spite of an apparently curative operation and discontinuation of hydralazine, P-ANCA remains strongly positive, he has had no recovery of renal function and has progressed to dialysis dependence.