Pulmonary-renal syndromes: Experience from an Indian Intensive Care Unit

Srinivas Rajagopala; Baburao Kanthamani Pramod Sagar; Molly Mary Thabah; B H Srinivas; Ramanathan Venkateswaran; Sreejith Parameswaran

doi:10.4103/0972-5229.158261

Pulmonary-renal syndromes: Experience from an Indian Intensive Care Unit

Indian J Crit Care Med. 2015 Jun;19(6):316-25. doi: 10.4103/0972-5229.158261.

Authors

Srinivas Rajagopala¹, Baburao Kanthamani Pramod Sagar¹, Molly Mary Thabah¹, B H Srinivas², Ramanathan Venkateswaran¹, Sreejith Parameswaran³

Affiliations

¹ Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Puducherry, India.
² Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Puducherry, India.
³ Department of Nephrology, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Puducherry, India.

Abstract

Background: The etiology of patients presenting with pulmonary-renal syndrome (PRS) to Intensive Care Units (ICUs) in India is not previously reported.

Aims: The aim was to describe the prevalence, etiology, clinical manifestations, and outcomes of PRS in an Indian ICU and identify variables that differentiate immunologic causes of PRS from tropical syndromes presenting with PRS.

Materials and methods: We conducted a prospective observational study of all patients presenting with PRS over 1-year. Clinical characteristics of patients with "definite PRS" were compared with those with "PRS mimics".

Results: We saw 27 patients with "provisional PRS" over the said duration; this included 13 patients with "definite PRS" and 14 with "PRS mimics". The clinical symptoms were similar, but patients with PRS were younger and presented with longer symptom duration. Ninety-two percent of the PRS cohort required mechanical ventilation, 77% required vasopressors and 61.5% required dialysis within 48 h of ICU admission. The etiologic diagnosis of PRS was made after ICU admission in 61.5%. Systemic lupus erythrematosus (54%) was the most common diagnosis. A combination of biopsy and serology was needed in the majority (69%, 9/13). Pulse methylprednisolone (92%) and cyclophosphamide (61.5%) was the most common protocol employed. Patients with PRS had more alveolar hemorrhage, hypoxemia and higher mortality (69%) when compared to "PRS mimics".

Conclusion: The spectrum of PRS is different in the tropics and tropical syndromes presenting with PRS are not uncommon. Multicentric studies are needed to further characterize the burden, etiology, treatment protocols, and outcomes of PRS in India.

Keywords: Crescentic glomerulonephritis; diffuse alveolar hemorrhage; pulmonary-renal; rapidly progressive renal failure; systemic lupus erythrematosus.