2017, Number 3
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Med Crit 2017; 31 (3)
Pulmonary-renal syndrome, case report and literature review
Delgado GME, Villagómez OAJ, Méndez RR, Marín RMC, Trujillo RN
Language: Spanish
References: 17
Page: 164-170
PDF size: 351.97 Kb.
ABSTRACT
The complex syndrome lung-kidney or pulmonary renal syndrome (PRS) is defined as the combination of diffuse alveolar hemorrhage accompanied by rapidly progressive glomerulonephritis, within the diagnostic protocol levels of anti-cytoplasm (ANCA), bronchoscopy, chest tomography and study required urinary sediment, occurs more commonly in males between 40 and 55 years, being rare in young people, described three main forms granulomatosis with polyangiitis, Churg Strauss syndrome Goodpasture (SGP), in any of its presentations is associated with a high mortality rate requiring multidisciplinary management with ventilatory support, replacement of renal function, specific management with systemic steroid and immunosuppressive therapy. The introduction of cyclophosphamide in combination with steroids announced an alternative in the treatment of vasculitis finding decrease mortality compared with glucocorticoids as monotherapy. The aim of this paper is to present the case of a patient with PSR, review the pathogenesis, diagnosis and treatment approach, emphasizing the importance of multidisciplinary management in the Intensive Care Unit.
REFERENCES
Papiris SA, Manali ED, Kalomenidis I, Kapotsis GE, Karakatsani A, Roussos C. Bench-to-bedside review: pulmonary-renal syndromes an update for the intensivist. Crit Care. 2007;11:213. (doi:10.1186/cc5778)
Risso JA, Mazzocchi O, De All J, Gnocchi CA. Síndrome pulmón riñón. Medicina (Buenos Aires). 2009;69(6):663-673.
Bacon PA. The spectrum of Wegener’s granulomatosis and disease relapse. N Engl J Med. 2005;352(4):330-332.
McCabe C, Jones Q, Nokolopoulou A, Wathen C, Luqmani R. Pulmonary-Renal Syndrome: An update for respiratory physicians. Respir Med. 2011;105:1413-1421.
Campos Z, Vazquez SI, Rodriguez W. The Pulmonary renal syndrome in a double positive anti GBM, P-ANCA middle aged patient. Am J Respir Crit Care Med. 2012;1:185. (doi: 10.1164/ajrccm.151.2.7842182)
Rodriguez W, Hanania N, Guy E, Guntupalli J. Pulmonary-renal syndrome in the intensive care unit. Crit Care Clin. 2002;18:881-895.
Kimmel M, Niko, Mark B, Alscher D. Differential diagnosis of the pulmonary-renal syndrome, an update on glomerulopathies. Clinical and Treatment Aspects. 2011; 17: 292-298.
Silva F, Cisternas M. Vasculitis asociada a anticuerpos anti-citoplasma de neutrofilos:avances en patogenia y tratamiento. Rev Med Chile. 2013;141:765-773.
Desai A, Goldschmidt RA, Kim GC. Sequential development of pulmonary renal síndrome associated with c-ANCA 3 years after development of anti GBM glomerulonephritis. Nephrol Dial Transplant. 2007;22:926-929.
Sánchez AP, World DM. Therapeutic apheresis for renal disorders. Semin Dial. 2012;25(2):119-131.
Cordoba JP, González C, Huerfano M, Vela F, Rodríguez P. Síndrome pulmón riñón: serie de casos del Hospital Universitario San Ignacio. Rev Colomb Reumatol. 2015;22(1):11-15.
West SC, Arulkumaran N, Ind PW, Pusey CD. Pulmonary renal Syndrome: a life threatening but treatable condition. Postgrad Med J. 2012;89:274-283. doi: 10.1136/postgradmedj-2012-131416. Epub 2013 Jan 24.
Jara LJ, Vera-Lastra O, Calleja MC. Pulmonary-renal vasculitic disorders: differential diagnosis and management. Curr Rheumatol Rep. 2003;5:107-115.
Susmita K, Misra S, Kumar H, Arpita R. Pulmonary renal syndrome on case of Wegener’s granulomatosis. Indian J Chest Dis Allied Sci. 2013;55:49-52.
Bolton WK. Pulmonary renal syndrome and emergency therapy, cardiorenal syndromes in critical care. Contrib Nephrol, Basel, karger. 2010;165;166-173.
Cohen TJ, Hauser T, Luqmani R, Morgan MD, Au Peh C et al. Rituximab versus cyclophosphamide in ANCA-associated renal vasculitis. N Engl J Med. 2010;363:211-220.
Walters G. Role of therapeutic plasmapheresis in ANCA-associated vasculitis. Pediatr Nephrol. 2016;31:217-225.