Acute Pulmonary - Renal Syndrome

Patients with pulmonary infiltrates and deteriorating renal function require urgent investigation. The possibility of a vasculitis must be considered. Check the urine for an active sediment, undertake screening tests as indicated below and consult early with Respiratory Physician / Immunologist / Rheumatologist / Nephrologist.


Acute Pulmonary - Renal Syndrome
Suspected diagnosis	Screening tests
A: Idiopathic Vasculitis
Granulomatosis with polyangiitis (Wegener's)	PR3 ANCA⁽¹⁾
Microscopic polyangiitis	MPO ANCA⁽¹⁾
Anti GBM Disease	Anti-GBM⁽¹⁾
SLE	ANA/dsDNA, C3, C4
Mixed cryoglobulinaemia	Cryoglobulins, RF, C3, C4, SPE
B: Non-Vasculitic
Renal vein thrombosis/PE	Radiological
TTP	CBC and blood film
C: Infective (a rare cause)
Mycoplasma	Nasopharyngeal swab for PCR, IgM antibody
Legionella	sputum for PCR, urinary antigen (L. pneumophila serogroup 1 only) and serology (acute and convalescent)
Mycobacterium	Sputum ZN stain
S. pneumoniae	Sputum Gram stain
Request "urgent vasculitis screen".


Information about this CDHB document (3854):
Document Owner:	Blue Book Editorial Committee (see Who's Who)
Issue Date:	December 2013
Next Review:	December 2015
Keywords:
Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document.
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Topic Code: 3854