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• W2956122691 abstract "Pulmonary renal syndrome is a group of disorders where we see rapidly progressive glomerulonephritis and diffuse alveolar syndrome. We present a case of post streptococcal pulmonary renal syndrome A 45 year old Sri Lankan Male, dairy farmer by occupation, presented with hemoptysis and increasing shortness of breath for 2 days. His history included a recent travel to Sri Lanka, where he had been unwell 2 weeks preceding the admission with upper respiratory tract symptoms and was given a course of antibiotics. At the time of presentation, his oxygen saturation was low and hence he was started on non-invasive ventilation. His renal function was impaired and urine microscopy showed dysmorphic red cells. Serology for HIV, Hepatitis B and C and Leptospirosis and cultures for TB were all negative. Because of recent history of upper respiratory tract infection, streptococcal antibody titres were done which was significantly positive for both antistreptolysin O titer and Anti DNAase –B, which would be consistent with recent streptococcus pyogenes infection. Antibody screen for anti GBM, ANCA and ANA were negative. CT scan of the chest showed changes consistent with diffuse alveolar haemorrhage and this was confirmed with bronchoscopy ( see below). He underwent a renal biopsy, which was consistent with Post infectious glomerulonephritis (histology below). Given his presentation and worsening respiratory status, Plasma exchange was performed and he was started on pulse methylprednisone. Patient was switched to oral prednisone, which was slowly weaned over 8 weeks and patient made completely recovery both from a respiratory and renal perspective. Discussion: This is an extremely rare case of pulmonary renal syndrome in the setting of post streptococcal pharyngitis. So far, only 5 such cases have been reported. Post streptococcal glomerulonephritis develops approximately 10 days to 2 weeks after streptococcal pharyngitis. It presents with oliguric renal failure, hematuria and hypertension, however most patients present with mild disease. It is very unusual to develop diffuse alveolar haemorrhage to develop in association with PSGN. Mechanism of diffuse alveolar haemorrhage in relation to streptococcal infection is not clear. Possible theory is patients with haemolytic streptococcal infection, the released nephritogenic antigen include nephritis associated plasmin receptor and streptococcal pyrogenic exotoxin B. These antigens accumulate in the glomeruli, trap and maintain the activity of plasmin and induce the degranulation of glomerular basement membrane. The host immunity generates antibody and there is deposition of immune complexes in the sub-epithelial space. A similar process may occur in lung tissue causing diffuse alveolar haemorrhage. Diffuse Alveolar Haemorrhage is a life threatening condition. When pulmonary capillaritis is the pathology of haemorrhage, as in pauci-immune glomerulonephritis or Good Pastures disease, it responds to plasma exchange and pulse intravenous steroids followed by oral steroids. Consistent with this, our patients hemoptysis and respiratory distress completely resolved and renal impairment improved back to normal levels after therapy. Acute pulmonary renal syndrome can occur in the post streptococcal glomerulonephritis. Timely therapy with Plasma exchange and steroids helps in complete resolution.View Large Image Figure ViewerDownload Hi-res image Download (PPT)" @default.
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• W2956122691 date "2019-07-01" @default.
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• W2956122691 title "MON-046 POST-STREPTOCOCCAL ACUTE PULMONARY RENAL SYNDROME" @default.
• W2956122691 doi "https://doi.org/10.1016/j.ekir.2019.05.833" @default.
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