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Am J Med Sci. 2009 Jun;337(6):411-4. doi: 10.1097/MAJ.0b013e3181928d24.

Severe pulmonary hemorrhage in patients with end-stage renal disease in antineutrophil cytoplasmic autoantibody-associated vasculitis.

Author information

1
Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health of China, Beijing 100034, China. leimeng@public3.bta.net.cn

Abstract

BACKGROUND:

It has been reported that after patients with antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV) progress to end-stage renal disease (ESRD), they are less likely to experience relapse of vasculitis. However, we encountered a few patients with ESRD suffering severe pulmonary hemorrhage caused by relapse of AAV. The current study presents our observation on these patients.

METHODS:

Of 198 consecutive patients with AAV with follow-up data in our center, 66 progressed to ESRD during follow-up. Clinical and laboratory data were collected and retrospectively analyzed.

RESULTS:

Among the 66 patients with ESRD, 5 experienced severe pulmonary hemorrhage. They had positive serum perinuclear ANCA and myeloperoxidase ANCA and were diagnosed as microscopic polyangiitis. All 5 patients achieved remission after initial induction therapy. The average duration of follow-up was 47.0 (range 8.0-98.0) months. After progressing to ESRD and starting hemodialysis, these patients experienced severe pulmonary hemorrhage within 9.0 (range 2.0-23.0) months. After immunosuppressive therapy, pulmonary hemorrhage ceased in 4 patients, and the other died of respiratory failure.

CONCLUSIONS:

Severe pulmonary hemorrhage can occur in ESRD patients with AAV. Disease activity and relapses of AAV should be monitored even after patients progress to ESRD.

PMID:
19359982
DOI:
10.1097/MAJ.0b013e3181928d24
[Indexed for MEDLINE]
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