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Pulmonary-renal syndrome: a life threatening but treatable condition
  1. Stephen C West1,
  2. Nishkantha Arulkumaran1,
  3. Philip W Ind2,
  4. Charles D Pusey1
  1. 1Renal Section, Department of Medicine, Imperial College London, Hammersmith Hospital, London, UK
  2. 2Respiratory Section, Department of Medicine, Imperial College London, Hammersmith Hospital, London, UK
  1. Correspondence to Dr Nishkantha Arulkumaran, Renal Section, Department of Medicine, Hammersmith Hospital, 5th Floor Commonwealth Building, Ducane Road, London W12 0NN, UK; nish_arul{at}yahoo.com

Abstract

Pulmonary renal syndrome (PRS) describes the occurrence of renal failure in association with respiratory failure, characterised by autoimmune-mediated rapidly progressive glomerulonephritis (RPGN) and diffuse alveolar haemorrhage (DAH), respectively. PRS is associated with significant morbidity and mortality, and prompt diagnosis and treatment significantly improve outcomes. Prompt diagnosis of PRS requires a high index of suspicion, as clinical features are non-specific, and immunological testing aids the diagnosis in many cases. The diagnostic evaluation of DAH and RPGN is outlined in the context of the important differential diagnoses. The commonest causes of PRS include antineutrophil cytoplasm antibody (ANCA)-associated vasculitis and antiglomerular basement membrane disease. As such, more emphasis has been placed on these two conditions in addition to an overview of the less common causes of PRS. We provide a practical review of the diagnostic evaluation, current treatment strategies and clinical outcomes of PRS for renal, respiratory and general physicians.

  • General Medicine (see Internal Medicine)

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