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A Case Report of Pulmonary‐Renal Syndrome Treated With Continuous Hemodiafiltration and Hemodialysis
Author(s) -
Uji Yoshitaka,
Shimizu Tomoharu,
Yoshioka Toyokazu,
Yamamoto Hiroshi,
Endo Yoshihiro,
Tani Toru
Publication year - 2006
Publication title -
therapeutic apheresis and dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.415
H-Index - 53
eISSN - 1744-9987
pISSN - 1744-9979
DOI - 10.1111/j.1744-9987.2006.00411.x
Subject(s) - medicine , hemodialysis , anti neutrophil cytoplasmic antibody , anuria , methylprednisolone , chest radiograph , renal replacement therapy , mechanical ventilation , renal function , pulmonary function testing , vasculitis , surgery , cardiology , lung , disease
This case describes a 40‐year‐old man complaining of general malaise, dyspnea with hemoptysis and anuria. Laboratory data indicated renal failure and the presence of systemic inflammation. His chest radiograph and computed tomography showed bilateral diffuse interstitial alveolar infiltration. These findings indicated acute deterioration of chronic renal dysfunction complicated by interstitial pneumonitis. He initially received daily conventional hemodialysis (HD), an antibiotic and oxygen therapy. However, his renal and pulmonary function continued to deteriorate. Antineutrophil cytoplasm antibodies against myeloperoxidase (MPO‐ANCA) and antibodies against proteinase 3 (PR3‐ANCA) were negative. We suspected that his pulmonary‐renal syndrome was caused by ANCA‐negative vasculitis. We applied mechanical ventilation, pulsed methylprednisolone therapy and continuous hemodiafiltration (CHDF) combined with HD. PaO 2 /FiO 2 ratio and mean pulmonary arterial pressure gradually improved after initiation of CHDF. He was finally separated from mechanical ventilation after 44 days in the hospital. He is currently alive with the support of conventional HD.