tailieunhanh - Báo cáo khoa học: "Bench-to-bedside review: Pulmonary–renal syndromes – an update for the intensivist"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Bench-to-bedside review: Pulmonary–renal syndromes – an update for the intensivist. | Available online http content 11 3 213 Review Bench-to-bedside review Pulmonary-renal syndromes -an update for the intensivist Spyros A Papiris1 Effrosyni D Manali1 loannis Kalomenidis1 Giorgios E Kapotsis1 Anna Karakatsani1 and Charis Roussos2 12nd Pulmonary Department National and Kapodistrian University of Athens Attikon University Hospital Athens Greece 2 Department of Critical Care and Pulmonary Services National and Kapodistrian University of Athens Evangelismos Hospital Athens Greece Corresponding author Spyros A Papiris papiris@ Published 2 May 2007 This article is online at http content 11 3 213 2007 BioMed Central Ltd Critical Care 2007 11 213 doi cc5778 Abstract The term pulmonary-renal syndrome refers to the combination of diffuse alveolar haemorrhage and rapidly progressive glomerulonephritis. A variety of mechanisms such as those involving anti-glomerular basement membrane antibodies antineutrophil cytoplasm antibodies or immunocomplexes and thrombotic microangiopathy are implicated in the pathogenesis of this syndrome. The underlying pulmonary pathology is small-vessel vasculitis involving arterioles venules and frequently alveolar capillaries. The underlying renal pathology is a form of focal proliferative glomerulonephritis. lmmunofluorescence helps to distinguish between anti-glomerular basement membrane disease linear deposition of lgG lupus and postinfectious glomerulonephritis granular deposition of immunoglobulin and complement and necrotizing vasculitis pauci-immune glomerulonephritis . Patients may present with severe respiratory and or renal failure and require admission to the intensive care unit. Since the syndrome is characterized by a fulminant course if left untreated early diagnosis exclusion of infection close monitoring of the patient and timely initiation of treatment are crucial for the patient s outcome. Treatment consists of corticosteroids in high doses and cytotoxic agents coupled with