title: Plasmapheresis in diffuse alveolar hemorrhage as perinuclear antineutrophil cytoplasmic antibody-associated vasculitis relapse on hemodialysis.
abstract: Unlike Goodpasture's syndrome with diffuse alveolar hemorrhage (DAH), there are scarce reports on the use of plasmapheresis for patients with a recurrence of DAH associated with antineutrophil cytoplasmic antibody (ANCA)-associated small vessel vasculitis (AAV) on hemodialysis. We report a case of a relapse of perinuclear-AAV with DAH, five months after starting hemodialysis. The patient received apheresis and induction immunosuppressive therapy, added to a short course of daily hemodialysis treatments. The DAH resolved with seven apheresis procedures and there were no adverse effects. We suggest that patients on hemodialysis with a relapse of AAV and DAH would benefit from the prompt initiation of apheresis in combination with aggressive immunosuppressive therapy. Pulmonary hemorrhage is not included in the current guidelines for therapeutic apheresis; therefore, we report this case and, if warranted, propose this condition to be included in the guidelines.
authors.affiliation: Department of Nephrology, Hospital da Costa, Burela, Spain. scigarran@udc.es
authors.forename: Secundino
authors.initials: S
authors.lastname: Cigarrán
authors.forename: María Jesús
authors.initials: MJ
authors.lastname: Castro
authors.forename: Montserrat
authors.initials: M
authors.lastname: Pousa
authors.forename: Sonia
authors.initials: S
authors.lastname: Paredes
authors.forename: Hugo
authors.initials: H
authors.lastname: Bernardo
authors.forename: Montserrat
authors.initials: M
authors.lastname: Porteiro
mesh_terms: D000368:Aged; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000150:complications / Q000628:therapy*; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D010956:Plasmapheresis / Q000379:methods*; D011650:Pulmonary Alveoli / Q000473:pathology; D012008:Recurrence; D006435:Renal Dialysis