Pulmonary Hemorrhage in Renal Disease: Goodpasture's Syndrome and Other Causes

Abstract

Pulmonary hemorrhage is generally due to neoplasm, tuberculosis, necrotizing pneumonia, or bronchiectasis. If these are not found, kidney diseases, including anti-glomerular basement membrane antibody-induced bleeding (Goodpasture's syndrome), should be considered. Hemoptysis in renal disease is more often due to azotemic hypervolemia than immune reaction. Typically linear immunofluorescent patterns along the glomerular and pulmonary alveolar basement membranes must be demonstrated to confirm the diagnosis of Goodpasture's syndrome.

Immune complex mediated lung haemorrhage and nephritis—successful treatment with plasma exchange, haemodialysis and immunosuppressive drug therapy

“…Haemoptysis is uncommon in renal failure; once fluid overload and pulmonary infection have been excluded the most likely cause is antiglomerular basement membrane (anti-GBM) disease with an associated proliferative nephritis with crescents (Schwartz et al, 1977). It is this condition that is now known as Goodpasture's syndrome whereas before the introduction of immunological studies this eponym was applied to all cases of lung haemorrhage and nephritis (Martinez and Kohler, 1971).…”

Massive Hemoptysis: Pathogenesis and Management

“…®tbers Although they are uncommon causes of massive hemoptysis, two other disease categories warrant mention because of the unique ways in which they lead to massive hemoptysis. Goodpasture's syndrome causes hemoptysis by an immune complex-mediated vasculitis in which antiglomerular basement membrane antibodies crossreact with alveolar capillary basement membranes[54]. The resultant breakdown in the integrity of the pulmonary microvasculature leads to bleeding into the alveolar spaces that may or may not be associated with frank hemoptysis.…”