Pulmonary Injury Caused by Anti-Basement Membrane Antibodies

Rees, Andrew J.

doi:10.1055/s-2007-1011461

Cited by 16 publications

(4 citation statements)

References 31 publications

(60 reference statements)

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“…Extravascular blood increases the uptake of carbon monoxide [ 61 ]. If this blood is present in the alveoli, clearance of the carbon monoxide radioisotope will be reduced, resulting in a low transfer coefficient [ 62 ].…”

Section: Diagnostic Evaluationmentioning

confidence: 99%

Pulmonary renal syndrome: a clinical review

Boyle

O'Callaghan

Ataya

et al. 2022

Breathe

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The term “pulmonary renal syndrome” describes a clinical syndrome which is characterised by the presence of both diffuse alveolar haemorrhage and glomerulonephritis. It encompasses a group of diseases with distinctive clinical and radiological manifestations, as well as different pathophysiological processes. The most common diseases implicated are anti-neutrophil cytoplasm antibodies (ANCA)-positive small vessel vasculitis and anti-glomerular basement membrane (anti-GBM) disease. Prompt recognition is required as respiratory failure and end-stage renal failure can rapidly occur. Treatment includes a combination of glucocorticoids, immunosuppression, plasmapheresis and supportive measures. The use of targeted treatments has significantly reduced mortality. Thus, an understanding of pulmonary renal syndrome is essential for the respiratory physician.

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Section: Diagnostic Evaluationmentioning

confidence: 99%

Pulmonary renal syndrome: a clinical review

Boyle

O'Callaghan

Ataya

et al. 2022

Breathe

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“…Pulmonary collagen (specifically the NC1 domain of the ␣-3 chain), which is a major component of glomerular and alveolar basement membranes [71]. Because not all patients with these pathologic antibodies develop both DAH and glomerulonephritis [72], the term ABMA disease is now used to describe the clinical spectrum of disease [10].…”

Section: Henoch-schönlein Purpuramentioning

confidence: 99%

“…Concurrent pulmonary and renal involvement occurs in up to 80% of cases [72]. Isolated glomerulonephritis occurs in most of the remaining cases, while sole DAH occurs in less than 10% of cases [6,72].…”

Section: Henoch-schönlein Purpuramentioning

confidence: 99%

Diffuse Alveolar Hemorrhage

Olson¹,

Schwarz²

2007

Diffuse Parenchymal Lung Disease

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Diffuse alveolar hemorrhage (DAH) refers to a clinical syndrome resulting from injury to the alveolar capillaries, arterioles, and venules leading to red blood cell accumulation in the distal air spaces. It is defined by the clinical triad of hemoptysis, anemia, and progressive hypoxemia. Chest radiographs reveal non-specific patchy or diffuse, bilateral pulmonary infiltrates.The diagnosis requires confirmation of the alveolar hemorrhage by bronchoscopy in which serial bronchoalveolar lavage samples reveal persistently hemorrhagic fluid. A number of conditions are associated with DAH, and underlying disease determines the prognosis and the treatment regimen. While there is no uniformly accepted classification of DAH, it is generally categorized according to the underlying histology. EtiologyA number of conditions have been associated with the clinical syndrome of DAH (table 1). In one study of biopsyconfirmed DAH, Wegener's granulomatosis (WG) was the most frequent underlying condition, followed by Goodpasture's syndrome, idiopathic pulmonary hemosiderosis, and collagen vascular diseases. Overall, vasculitis (either WG or microscopic polyangiitis [MAP]) was the most frequent, representing 41% of cases [1].

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“…Anuria, an increased number of crescents on renal biopsy, and the severity of AH were associated with a poorer prognosis. Relapse is associated with episodes of infection, volume overload, and cigarette smoking but not circulating ABMA levels [10,49,63]. The long-term pulmonary complications of Goodpasture's syndrome have not been well characterized, with most patients having a normal chest radiograph on follow-up.…”

Section: Treatmentmentioning

confidence: 99%

Alveolar Hemorrhage

Sandur

Dweik

Arroliga

1998

J Intensive Care Med

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Alveolar hemorrhage (AH) is a clinical syndrome with diverse etiologies both immune and nonimmune. The defining pathological feature of AH is the presence or absence of pulmonary capillaritis. The antineutrophil cytoplasmic antibody (ANCA) related vasculitis and systemic lupus erythematosus are the commonest causes of immune AH with pulmonary capillaritis, whereas Goodpasture's syndrome and idiopathic pulmonary hemosiderosis are common causes of immune AH without pulmonary capillaritis. The major nonimmune causes of AH are primarily drug induced, or due to hematological malignancy and disorders of coagulation. Clinical features of AH include: dyspnea, fever, hemotypsis, bilateral crackles and pallor. Hypoxemia and bilateral diffuse airspace disease on the chest radiograph with relative sparing of the bases and apices which most often clears within 48 hours after its onset further characterize this syndrome. The major clinical implications of this syndrome are its potential to cause respiratory failure in severe cases and its sequelae of pulmonary fibrosis with associated morbidity and disability. In addition, AH may be the initial manifestation of a systemic immune disorder which can be managed optimally if recognized early. The diagnosis of AH is confirmed by bronchoalveolar lavage by demonstrating a progressively bloody return on successive aliquots of instilled saline or hemosiderin laden macrophages in the bronchoalveolar lavage fluid. The open lung biopsy remains the gold standard for the diagnosis of AH but is reserved for inapparent cases in whom corticosteroids and immunosuppressive therapy may be life saving. Serologic testing and examination of the urine sediment are useful adjuncts to the diagnosis. The treatment of AH is primarily supportive while an attempt is made to determine its etiology and initiate specific therapy. Glucocorticoids and cyclophosphamide are the cornerstones of therapy in immune AH with adjunctive plasmapheresis in life-threatening cases.

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Pulmonary Injury Caused by Anti-Basement Membrane Antibodies

Cited by 16 publications

References 31 publications

Pulmonary renal syndrome: a clinical review

Pulmonary renal syndrome: a clinical review

Diffuse Alveolar Hemorrhage

Alveolar Hemorrhage

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