title: A case report of pulmonary-renal syndrome treated with continuous hemodiafiltration and hemodialysis.
abstract: This case describes a 40-year-old man complaining of general malaise, dyspnea with hemoptysis and anuria. Laboratory data indicated renal failure and the presence of systemic inflammation. His chest radiograph and computed tomography showed bilateral diffuse interstitial alveolar infiltration. These findings indicated acute deterioration of chronic renal dysfunction complicated by interstitial pneumonitis. He initially received daily conventional hemodialysis (HD), an antibiotic and oxygen therapy. However, his renal and pulmonary function continued to deteriorate. Antineutrophil cytoplasm antibodies against myeloperoxidase (MPO-ANCA) and antibodies against proteinase 3 (PR3-ANCA) were negative. We suspected that his pulmonary-renal syndrome was caused by ANCA-negative vasculitis. We applied mechanical ventilation, pulsed methylprednisolone therapy and continuous hemodiafiltration (CHDF) combined with HD. PaO(2)/FiO(2) ratio and mean pulmonary arterial pressure gradually improved after initiation of CHDF. He was finally separated from mechanical ventilation after 44 days in the hospital. He is currently alive with the support of conventional HD.
authors.affiliation: Department of Surgery, Shiga University of Medical Science, Shiga, Japan. yendo@belle.shiga-med.ac.jp
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Uji
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Shimizu
authors.forename: Toyokazu
authors.initials: T
authors.lastname: Yoshioka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Endo
authors.forename: Toru
authors.initials: T
authors.lastname: Tani
mesh_terms: D000328:Adult; D002097:C-Reactive Protein / Q000032:analysis; D003131:Combined Modality Therapy; D005938:Glucocorticoids / Q000008:administration & dosage; D017583:Hemodiafiltration; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy*; D007962:Leukocytes; D017563:Lung Diseases, Interstitial / Q000150:complications*; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D011188:Potassium / Q000032:analysis; D020551:Pulse Therapy, Drug; D006435:Renal Dialysis; D013577:Syndrome; D014057:Tomography, X-Ray Computed; D014657:Vasculitis / Q000150:complications
chemical_list: D005938:Glucocorticoids; D002097:C-Reactive Protein; D011188:Potassium; D008775:Methylprednisolone