Diffuse alveolar hemorrhage in lupus nephritis.
OBJECTIVE
Diffuse alveolar hemorrhage (DAH) is a rare and catastrophic event in systemic lupus erythematosus (SLE) with a high mortality rate, and little information is available about the degree of renal involvement in this condition.


METHODS
To evaluate the effects of renal impairment on the course of DAH, the hospital records of 7 patients (9 episodes) with DAH and SLE between 1988 and 1998 at Seoul National University Hospital were reviewed. A diagnosis of DAH was established when the patient had an acute pulmonary syndrome including either hemoptysis, new alveolar infiltrates on the chest radiograph, the presence of a falling hematocrit or hemorrhagic BAL. All patients were women and their median age was 26 years ranging between 23 and 39. All patients had concurrent lupus nephritis and 4 of them were classified as WHO class IV with renal pathology.


RESULTS
Their median serum creatinine level at the time of DAH was 4.6 mg/dl (0.8 - 13.6), and the median daily proteinuria amount was 778 mg (436 - 6200). All of the patients received corticosteroid therapy, and intravenous cyclophosphamide was given to 3 cases. Hemodialysis was done in 3 cases, and 4 of the 7 patients died during an acute event. We reviewed five series about the clinical parameters, including the serum creatinine level, treatment and hospital outcome. From the results of the analysis, it was determined that concomitant infection (RR 4.2) and the use of mechanical ventilation (RR 6.1) were associated with the increased risk of mortality, but azotemia (sCr > 3.0 mg/dl) (RR 1.5) or hemodialysis therapy (RR 1.3) was not shown to have a significant association.


CONCLUSIONS
It could be suggested that even though renal failure is combined with DAH in SLE patients, the same aggressive treatment results in a comparable outcome as patients with normal renal function.
Lee
J G
JG
Department of Internal Medicine, Eulji University School of Medicine, Seoul, Korea.
Joo
K W
KW
Chung
W K
WK
Jung
Y C
YC
Zheung
S H
SH
Yoon
H J
HJ
Kim
Y S
YS
Ahn
C
C
Han
J S
JS
Kim
S
S
Lee
J S
JS
D000208:Acute Disease; D000328:Adult; D005260:Female; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D006801:Humans; D008171:Lung Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D008181:Lupus Nephritis / Q000150:complications* / Q000628:therapy; D011859:Radiography; D012189:Retrospective Studies; D015996:Survival Rate