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VOLUME 19 , ISSUE 6 ( 2015 ) > List of Articles

ORIGINAL ARTICLE

Pulmonary-renal syndromes: Experience from an Indian Intensive Care Unit

Baburao Kanthamani Pramod Sagar, Molly Mary Thabah, B.H. Srinivas, Sreejith Parameswaran

Keywords : Crescentic glomerulonephritis, diffuse alveolar hemorrhage, pulmonary-renal, rapidly progressive renal failure, systemic lupus erythrematosus

Citation Information : Sagar BK, Thabah MM, Srinivas B, Parameswaran S. Pulmonary-renal syndromes: Experience from an Indian Intensive Care Unit. Indian J Crit Care Med 2015; 19 (6):316-325.

DOI: 10.4103/0972-5229.158261

License: CC BY-ND 3.0

Published Online: 01-05-2016

Copyright Statement:  Copyright © 2015; The Author(s).


Abstract

Background: The etiology of patients presenting with pulmonary-renal syndrome (PRS) to Intensive Care Units (ICUs) in India is not previously reported. Aims: The aim was to describe the prevalence, etiology, clinical manifestations, and outcomes of PRS in an Indian ICU and identify variables that differentiate immunologic causes of PRS from tropical syndromes presenting with PRS. Materials and Methods: We conducted a prospective observational study of all patients presenting with PRS over 1-year. Clinical characteristics of patients with "definite PRS" were compared with those with "PRS mimics." Results: We saw 27 patients with "provisional PRS" over the said duration; this included 13 patients with "definite PRS" and 14 with "PRS mimics." The clinical symptoms were similar, but patients with PRS were younger and presented with longer symptom duration. Ninety-two percent of the PRS cohort required mechanical ventilation, 77% required vasopressors and 61.5% required dialysis within 48 h of ICU admission. The etiologic diagnosis of PRS was made after ICU admission in 61.5%. Systemic lupus erythrematosus (54%) was the most common diagnosis. A combination of biopsy and serology was needed in the majority (69%, 9/13). Pulse methylprednisolone (92%) and cyclophosphamide (61.5%) was the most common protocol employed. Patients with PRS had more alveolar hemorrhage, hypoxemia and higher mortality (69%) when compared to "PRS mimics." Conclusion: The spectrum of PRS is different in the tropics and tropical syndromes presenting with PRS are not uncommon. Multicentric studies are needed to further characterize the burden, etiology, treatment protocols, and outcomes of PRS in India.

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  1. Goodpasture E. The significance of certain pulmonary lesions in relation to the etiology of influenza. Am J Med Sci 1919;158:863-70.
  2. Nath A, Rajagopala S. Pulmonary renal syndromes: A pulmonologist′s view. Clin Queries Nephrol 2015;4:1-10 doi:10.1016/j.cqn.2015.02.001. Last accessed on 2015 May 15.
  3. West SC, Arulkumaran N, Ind PW, Pusey CD. Pulmonary-renal syndrome: A life threatening but treatable condition. Postgrad Med J 2013;89:274-83.
  4. Gallagher H, Kwan JT, Jayne DR. Pulmonary renal syndrome: A 4-year, single-center experience. Am J Kidney Dis 2002;39:42-7.
  5. Rodriguez W, Hanania N, Guy E, Guntupalli J. Pulmonary-renal syndromes in the intensive care unit. Crit Care Clin 2002;18:881-95.
  6. Kothari VM, Karnad DR, Bichile LS. Tropical infections in the ICU. J Assoc Physician India 2006;54:291-8.
  7. Maroun E, Kushawaha A, El-Charabaty E, Mobarakai N, El-Sayegh S. Fulminant leptospirosis (Weil′s disease) in an urban setting as an overlooked cause of multiorgan failure: A case report. J Med Case Rep 2011;5:7.
  8. Little MA, Pusey CD. Rapidly progressive glomerulonephritis: Current and evolving treatment strategies. J Nephrol 2004;17:S10-9.
  9. Collard HR, Schwarz MI. Diffuse alveolar hemorrhage. Clin Chest Med 2004;25:583-92.
  10. Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, et al. 2012 revised International chapel hill consensus conference nomenclature of vasculitides. Arthritis Rheum 2013;65:1-11.
  11. Hochberg MC. Updating the American college of rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1997;40:1725.
  12. Al Bshabshe AA, Al-Khalidy H, Omer HA, Al-Amri DH, Hamad A, Abdulwahed SR, et al. Pulmonary renal syndrome associated with Wegener′s granulomatosis: A case report and review of literature. Clin Exp Nephrol 2010;14:80-4.
  13. Watts RA, Al-Taiar A, Scott DG, Macgregor AJ. Prevalence and incidence of Wegener′s granulomatosis in the UK general practice research database. Arthritis Rheum 2009;61:1412-6.
  14. Bambery P, Sakhuja V, Bhusnurmath SR, Jindal SK, Deodhar SD, Chugh KS. Wegener′s granulomatosis: Clinical experience with eighteen patients. J Assoc Physicians India 1992;40:597-600.
  15. Sharma A, Mittal T, Rajan R, Rathi M, Nada R, Minz RW, et al. Validation of the consensus methodology algorithm for the classification of systemic necrotizing vasculitis in Indian patients. Int J Rheum Dis 2014;17:408-11.
  16. Kumar A. Indian guidelines on the management of SLE. J Indian Rheumatol Assoc 2002;10:80-96.
  17. Santos-Ocampo AS, Mandell BF, Fessler BJ. Alveolar hemorrhage in systemic lupus erythematosus: Presentation and management. Chest 2000;118:1083-90.
  18. Shen M, Zeng X, Tian X, Zhang F, Zeng X, Zhang X, et al. Diffuse alveolar hemorrhage in systemic lupus erythematosus: A retrospective study in China. Lupus 2010;19:1326-30.
  19. Martínez-Martínez MU, Abud-Mendoza C. Diffuse alveolar hemorrhage in patients with systemic lupus erythematosus. Clinical manifestations, treatment, and prognosis. Reumatol Clin 2014;10:248-53.
  20. McCabe C, Jones Q, Nikolopoulou A, Wathen C, Luqmani R. Pulmonary-renal syndromes: An update for respiratory physicians. Respir Med 2011;105:1413-21.
  21. Semple D, Keogh J, Forni L, Venn R. Clinical review: Vasculitis on the intensive care unit - Part 1: Diagnosis. Crit Care 2005;9:92-7.
  22. Papiris SA, Manali ED, Kalomenidis I, Kapotsis GE, Karakatsani A, Roussos C. Bench-to-bedside review: Pulmonary-renal syndromes - An update for the intensivist. Crit Care 2007;11:213.
  23. Befort P, Corne P, Filleron T, Jung B, Bengler C, Jonquet O, et al. Prognosis and ICU outcome of systemic vasculitis. BMC Anesthesiol 2013;13:27.
  24. Cruz BA, Ramanoelina J, Mahr A, Cohen P, Mouthon L, Cohen Y, et al. Prognosis and outcome of 26 patients with systemic necrotizing vasculitis admitted to the intensive care unit. Rheumatology (Oxford) 2003;42:1183-8.
  25. Khan SA, Subla MR, Behl D, Specks U, Afessa B. Outcome of patients with small-vessel vasculitis admitted to a medical ICU. Chest 2007;131:972-6.
  26. Semple D, Keogh J, Forni L, Venn R. Clinical review: Vasculitis on the intensive care unit - Part 2: Treatment and prognosis. Crit Care 2005;9:193-7.
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