Diffuse alveolar hemorrhage in lupus nephritis

Jg. Lee et al., Diffuse alveolar hemorrhage in lupus nephritis, CLIN NEPHR, 55(4), 2001, pp. 282-288
Citations number
Categorie Soggetti
Urology & Nephrology","da verificare
Journal title
ISSN journal
0301-0430 → ACNP
Year of publication
282 - 288
SICI code
Aim: Diffuse alveolar hemorrhage (DAH) is a rare and catastrophic event in systemic lupus erythematosus (SLE) with a high mortality rate, and little i nformation is available about the degree of renal involvement in this condi tion. Patients and methods: To evaluate the effects of renal impairment on the course of DAH, the hospital records of 7 patients (9 episodes) with DAH and SLE between 1988 and 1998 at Seoul National University Hospital were r eviewed. A diagnosis of DAH was established when the patient had an acute p ulmonary syndrome including either hemoptysis, new alveolar infiltrates on the chest radiograph, the presence of a falling hematocrit or hemorrhagic B AL. All patients were women and their median age was 26 years ranging betwe en 23 and 39. All patients had concurrent lupus nephritis and 4 of them wer e classified as WHO class IV with renal pathology. Results: Their median se rum creatinine level at the time of DAH was 4.6 mg/dl (0.8 - 13.6), and the median daily proteinuria amount was 778 mg (436 - 6200). All of the patien ts received corticosteroid therapy, and intravenous cyclophosphamide was gi ven to 3 cases. Hemodialysis was done in 3 cases, and 4 of the 7 patients d ied during an acute event. We reviewed five series about the clinical param eters, including the serum creatinine level, treatment and hospital outcome . From the results of the analysis, it was determined that concomitant infe ction (RR 4.2) and the use of mechanical ventilation (RR 6.1) were associat ed with the increased risk of mortality, but azotemia (sCr > 3.0 mg/dl) (RR 1.5) or hemodialysis therapy (RR 1.3) was not shown to have a significant association. Conclusion: It could be suggested that even though renal failu re is combined with DAH in SLE patients, the same aggressive treatment resu lts in a comparable outcome as patients with normal renal function.