TITLE:
Alarming Presentation of a Seemingly Common Condition in a Patient with Renal Impairment
AUTHORS:
Mohammad Budruddin, Muhammad Yasir Khalil, Issa Al Salmi, Ramaiah Shilpa
KEYWORDS:
Haemoptysis; Renal Impairment; Pulmonary Renal Syndrome; Haemodialysis; ENA; ANCA; Vasculitis; Pulmonary Oedema
JOURNAL NAME:
Open Journal of Nephrology,
Vol.3 No.4,
December
13,
2013
ABSTRACT: We received a 23-year-old
male, working in the Army for 18 months, with advanced renal impairment,
haemoptysis and hyperkalemia. An impression of the pulmonary renal
syndrome was made and he was managed aggressively with haemodialysis, plasma
exchange and pulsing with methyl prednisolone. His condition improved, but the
renal functions did not. The vasculitic workup including Extractable
Nuclear Antigen (ENA) and Anti-Neutrophil Cytoplasmic Antibody (ANCA) which
were sent on admission came out to be negative. As he apparently responded to
the initial management protocol, he was subjected to renal biopsy which did not
reveal any vasculitis but was consistent for end-stage renal
disease. Subsequently he was subjected to lung biopsy which also was not
supportive for vasculitis. However, we concluded that the initial pointers for Wegener’s granulomatosis were misleading. The haemoptysis entirely subsided
as the congestion improved. He was maintained on Haemodialysis three times per
week schedule and discharged to the peripheral health care facility.