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Diffuse alveolar hemorrhage in lupus nephritis.
1Department of Internal Medicine, Eulji University School of Medicine, Seoul, Korea.
Clinical Nephrology
|May 4, 2001
Summary
Diffuse alveolar hemorrhage (DAH) in systemic lupus erythematosus (SLE) can occur with kidney disease. Aggressive treatment for DAH in SLE patients with renal impairment yields outcomes similar to those with normal kidney function.
Area of Science:
- Nephrology
- Rheumatology
- Pulmonology
Background:
- Diffuse alveolar hemorrhage (DAH) is a severe complication of systemic lupus erythematosus (SLE).
- Limited data exists on the impact of renal involvement on DAH outcomes in SLE patients.
- Lupus nephritis is common in SLE patients experiencing DAH.
Purpose of the Study:
- To investigate the influence of renal impairment on the clinical course and outcomes of DAH in SLE patients.
- To assess the relationship between renal function and mortality in SLE-associated DAH.
Main Methods:
- Retrospective review of 7 SLE patients (9 DAH episodes) from 1988-1998.
- Diagnosis of DAH based on acute pulmonary syndrome, hemoptysis, radiographic infiltrates, falling hematocrit, or hemorrhagic BAL.
- Analysis of clinical parameters including serum creatinine, proteinuria, treatment, and mortality.
Main Results:
- Median serum creatinine was 4.6 mg/dL; median proteinuria was 778 mg/day.
- Concomitant infection and mechanical ventilation increased mortality risk (RR 4.2 and 6.1, respectively).
- Azotemia (sCr > 3.0 mg/dL) and hemodialysis were not significantly associated with mortality.
Conclusions:
- SLE patients with DAH and renal failure can achieve comparable outcomes to those with normal renal function when treated aggressively.
- Aggressive treatment strategies should be considered for SLE patients with DAH, irrespective of renal status.
- Further research is warranted to optimize DAH management in SLE with coexisting nephritis.