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CURRENT ESSENTIALS OF CRITICAL CARE (PART 8)

Vasculitic hội chứng liên quan đến cả hai phổi và ho thận, khó thở, ho ra máu, xuất huyết phế nang, có thể có phát ban, trên sự tham gia của đường hô hấp tùy thuộc vào rối loạn tiểu máu kính hiển vi thường trước kịch phát suy thận Radiographically khuếch tán thâm nhiễm phế nang, đôi khi tổn thương cavitary phế quản rửa | 212 Current Essentials of Critical Care Pulmonary-Renal Syndromes Essentials of Diagnosis Vasculitic syndromes that involve both lungs and kidneys Cough dyspnea hemoptysis alveolar hemorrhage may have rash upper respiratory tract involvement depending on disorder Microscopic hematuria often precedes fulminant renal failure Radiographically diffuse alveolar infiltrates occasionally cavitary lesions Bronchoalveolar lavage with 20 hemosiderin-laden macrophages indicates alveolar hemorrhage nonspecific Need to exclude correlated pulmonary and renal disorders CHF with excessive diuresis renal failure complicated by pulmonary edema disseminated infection Drug toxin exposure history helpful penicillamine in Goodpasture syndrome SLE leukotriene inhibitors in Churg-Strauss syndrome hydrocarbon in Goodpasture disease hydralazine procainamide quinidine in SLE Serological markers ANCA anti-GBM ANA anti-dsDNA Definitive diagnosis often with renal biopsy with immunofluo-rescent staining Differential Diagnosis Wegener granulomatosis Goodpasture syndrome Microscopic polyangiitis Churg-Strauss syndrome Systemic lupus erythematosus SLE Treatment Maintain adequate airway in massive hemoptysis Hemodialysis may be indicated in acute renal failure Immunosuppressive agents corticosteroids cyclophosphamide Plasmapheresis in Goodpasture syndrome Adjunctive trimethoprim-sulfamethoxazole may be considered in Wegener granulomatosis Renal histopathology in SLE often determines treatment Pearl Though first believed that leukotriene inhibitors can trigger development of Churg-Strauss syndrome it is more likely that the use of these medications in steroid-dependent asthmatics unmasks clinical manifestations of a previously suppressed eosinophilic syndrome. Reference Rodriguez W et al Pulmonary-renal syndromes in the intensive care unit. Crit Care Clin 2002 18 881. PMID 12418445 Chapter 14 Renal Disorders 213 Renal Failure Acute Essentials of Diagnosis Abrupt reduction in renal function resulting