Abstract
The term pulmonary renal vasculitis syndrome describes a clinical syndrome of diffuse alveolar haemorrhage (DAH) complicating acute glomerulonephritis that often heralds severe, life-threatening systemic vasculitis requiring urgent, aggressive therapy. "Anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis" and glomerular basement membrane ("Goodpasture's") disease are the commonest causes but other pathologies including systemic lupus erythematosus and the anti-phospholipid syndrome are also implicated. Such patients hence present most commonly to rheumatologists and nephrologists but usually require input from a number of specialties, respiratory and critical care medicine in particular. Such care is typically provided in specialist centres able to offer plasma exchange and experience in the use of immunosuppressants. We review clinical features, advances in therapy and understanding of pathophysiology.
2010 Elsevier B.V. All rights reserved.
MeSH terms
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Animals
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Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / complications
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Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / immunology*
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Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / physiopathology
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Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / therapy
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Antibodies, Antineutrophil Cytoplasmic / immunology
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Antibodies, Antineutrophil Cytoplasmic / metabolism*
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Antiphospholipid Syndrome / complications
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Antiphospholipid Syndrome / immunology*
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Antiphospholipid Syndrome / pathology
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Antiphospholipid Syndrome / physiopathology
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Antiphospholipid Syndrome / therapy
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Glomerular Basement Membrane / immunology
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Glomerular Basement Membrane / pathology
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Glomerulonephritis / etiology
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Glomerulonephritis / immunology
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Glomerulonephritis / pathology
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Glomerulonephritis / physiopathology
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Glomerulonephritis / therapy
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Hemorrhage / etiology
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Hemorrhage / immunology
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Hemorrhage / pathology
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Hemorrhage / physiopathology
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Hemorrhage / therapy
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Humans
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Immunosuppressive Agents / therapeutic use
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Lung Diseases / etiology
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Lung Diseases / immunology
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Lung Diseases / pathology
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Lung Diseases / physiopathology
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Lung Diseases / therapy
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Lupus Erythematosus, Systemic / complications
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Lupus Erythematosus, Systemic / immunology*
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Lupus Erythematosus, Systemic / pathology
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Lupus Erythematosus, Systemic / physiopathology
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Lupus Erythematosus, Systemic / therapy
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Plasma Exchange
Substances
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Antibodies, Antineutrophil Cytoplasmic
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Immunosuppressive Agents
Supplementary concepts
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Rapidly progressive glomerulonephritis with pulmonary hemorrhage