What Is a Pulmonary Hemorrhage?

Pulmonary hemorrhage-nephritis syndrome may be a viral infection and / or inhalation of certain chemicals that cause primary lung damage. Due to the presence of cross-reactive antigens in the alveolar wall capillary basement membrane and the glomerular basement membrane, secondary renal injury can be caused.
Before the onset, many patients had respiratory infections, and repeated hemoptysis later, most of them appeared before kidney disease. X-ray examination showed diffuse or nodular shadows in the two lungs, spreading from the hilum to the surroundings, the apex of the lungs and the proximal diaphragm were clear, often heavier on one side, and some had no history of hemoptysis. A chest radiograph confirmed bleeding. During hemoptysis, diffuse lung function is reduced, hypoxemia occurs, and anemia is common.
Renal manifestations: Each case had proteinuria, red blood cells and casts, and gross hematuria.
Treatment measures: Integrative therapy with crescentic nephritis. Plasma exchange is used in combination with corticosteroids and cyclophosphamide to remove and reduce serum anti-renal basement membrane antibody concentration, and at the same time, it can remove substances , complement, etc., which are harmful to tissues in the body. In cases of ineffective plasma exchange and hormonal immunosuppressive agents, double nephrectomy can be considered. Patients with obvious pulmonary hemorrhage should be treated with peritoneal dialysis.

Pulmonary hemorrhage

Pulmonary hemorrhage-nephritis syndrome (Goodpasturessyndrome) may be caused by viral infection and / or inhalation of certain chemicals and cause primary lung damage. Due to the presence of cross-reactive antigens in the capillary basement membrane and glomerular basement membrane of the alveolar wall, it can cause secondary Primary kidney injury. The disease is characterized by hemoptysis, pulmonary infiltration, glomerulonephritis, and anti-basement membrane antibodies in blood and affected tissues.

Chinese name: Pulmonary hemorrhage

English name: Goodpasturessyndrome
Visiting department: Internal medicine

Overview of pulmonary hemorrhage

Causes of pulmonary hemorrhage

The exact cause has not been confirmed, but it is presumed to be related to infection, especially viral infection. There are other reports of history of exposure to gasoline hydrocarbon (hydrocarbon) compounds before the illness. Therefore, these chemicals and / or viruses may be considered as the causative factor. Renal disease is currently recognized. The principle is the immune response process of anti-basement membrane antibody-type nephritis. Due to certain pathological factors, primary alveolar septum and pulmonary capillary basement membrane are damaged. Due to the presence of cross-antigens between the basement membrane of the alveolar wall and the glomerular basement membrane, endogenous anti-basement membrane antibodies can react with the glomerular basement membrane to injure the diffuse bleeding on the glomerular lung surface. Edema and old Hemorrhagic microscopy showed that alveolar hemorrhages often phagocytized phagocytic cells containing hemosiderins. Alveolar fibrous tissue proliferation immunofluorescence examination showed alveolar septum and pulmonary capillary basement membrane with immunoglobulin and C3 linear deposition of kidney pathology. Changes in glomerulonephritis like radicals, and early glomerular capillaries show focal and segmental necrosis. Infiltration of lymphocytes as a characteristic

Pulmonary hemorrhage physiology

Due to respiratory virus infection, inhalation of chemicals (hydrocarbons or carbon monoxide) and other factors, causing patients with alveolar basement membrane antigenicity, resulting in anti-basement membrane resistance In the body, because the glomerular basement membrane and alveolar capillary basement membrane are related to cross-antigenicity, anti-alveolar basement membrane antibodies work in the alveolar capillary basement membrane and glomerulus to trigger pulmonary hemorrhage and nephritis. The patient's naked eye showed an enlarged lung shape, extensive bleeding on the surface, edema on the section, and old and new bleeding lesions. Microscopic examination showed hemorrhage in the alveoli and macrophages containing hemosiderin in the interstitial cavity. The alveolar structure remains intact, without arteriolar or vascular inflammation, but focal alveolar fibrosis is more common. Electron microscopy showed changes in alveolar basement membrane worship, alveolar basement membrane antibody deposition was fluorescently stained, and pulmonary capillary intima was almost normal. The syndrome is characterized by diffuse pulmonary hemorrhage, alveolar fibrosis, and glomerulonephritis.

Diagnosis of pulmonary hemorrhage

Before the onset, many patients had recurrent hemoptysis after respiratory infections. Most of them appeared before the kidney disease for a few years (up to 12 years) in the elderly and a few in a few months. X-ray examination occurred after nephritis. The lungs were diffuse. Or nodular shadow spreads from the hilum to the surroundings. The apex of the lungs and the near diaphragm are clear. The heavier hemoptysis is usually present on one side. However, sputum hemosiderin and chest radiographs confirm that there is hemorrhage. Hypopnea diffuse pulmonary function occurs. Common renal manifestations of hypoxemia and anemia: each case has proteinuria, red blood cells and casts, and may have gross hematuria and renal dysfunction. However, patients with different progression rates can show acute renal failure within 1 to 2 days. Within a few months, a small number of patients with uremia have a slower evolution and have stabilized at the original level or have relapsed after relapse. Serological examination: anti-glomerular basement membrane antibody titers are increased while other autoantibodies are negative. Individual cases have increased immunoglobulin resistance. Basement membrane antibody concentration is not necessarily proportional to the severity of pulmonary and renal lesions. Diagnosis can be made based on repeated hemoptysis, hematuria, X-ray signs, and positive hemosiderin cells in sputum. And will have idiopathic pulmonary hemosiderosis kidney disease to identify candidates after the onset of symptoms and diagnosis easier but necrotizing vasculitis of pulmonary and renal manifestations in CRF patients with hemoptysis identification

Pulmonary hemorrhage

1 General examination should usually include blood routine blood, biochemical renal function, arterial blood gas analysis, urine routine, etc. 2 Serum examination preliminary tests may include antinuclear antibody (ANA) spectrum anti-double-stranded (ds) DNA anti-neutrophil cytoplasmic antibody ANCA) anti-basement membrane (GBM) antibodies and anti-phospholipid antibodies SLE patients may have high titers of ANA and dsDNA and complement levels are reduced. Good anti-GBM antibody-positive ANCA includes circulating peri-type (P-ANCA) and cytoplasmic type Two of the former are antibodies to myeloperoxidase (MPO) elastase and lactoferrin, and the latter is targeted to serine protein 3 (PR3) distributed in the cytoplasm, which is polyarteritis under the C-ANCA microscope. Churg-Strauss Vasculitis and oligoimmune glomerulonephritis (PIGN) can be P-ANCA positive3 The choice of histological biopsy site depends on the specific disease, such as the diagnosis of Wechsler's granulomatosis, and nasal or sinus biopsy can be performed with a small invasive diagnosis 4 In addition to conventional light microscopy, renal biopsy usually requires direct immunofluorescence staining. Immune-mediated alveolar hemorrhage syndrome. When renal involvement is involved, the renal pathology is necrotizing glomerulonephritis. Histological changes The degree varies from mild mesangial thickening to severe crescentic glomerulonephritis and renal arterial vasculitis. Few diseases have immunofluorescent staining with different manifestations of anti-basement membrane antibody (ABMA) disease along the glomeruli. Basement membrane line-like deposition of collagen angiopathy and idiopathic immune complex-mediated glomerulonephritis are granular deposits, but the PIGN immunofluorescence test is negative and the serological ANCAABMAANA test can improve the significance of diagnosis and treatment and prognosis .
5 Bronchoscopy may not show obvious hemoptysis in patients with alveolar hemorrhage. Bronchoscopy and alveolar lavage (BAL) examinations can help diagnose alveolar hemorrhage, rule out infections and local airway bleeding, and help identify and find the cause. The increase can definitely be active bleeding. In addition, microscopic examination found that hemosiderin-containing cells also have the value of confirming alveolar hemorrhage. 6 Lung biopsy Transbronchial lung biopsy has limited diagnostic value for DAH. For a clear cause, a chest lung biopsy is required. Routine examination is still unclear, and the condition is relatively stable. Patients with severe pulmonary hemorrhage and respiratory failure who can tolerate unilateral lung collapse are not suitable for open chest lung biopsy. Lung biopsy can be accompanied by infection and pneumothorax.

Pulmonary hemorrhage treatment

Combined with crescentic nephritis, plasma exchange can be used in combination with corticosteroids and cyclophosphamide to remove and reduce the serum anti-renal basement membrane antibody concentration. At the same time, it can remove complement, which is a substance that damages tissues in the body, thereby reducing and improving kidneys. And lung disease, plasma exchange and hormonal immunosuppressive cases can be considered. Double nephrectomy for pulmonary hemorrhage is obvious. Peritoneal dialysis is appropriate for dialysis. Transition to a few months or more than half a year can be performed after the anti-renal basement membrane antibody in the blood is removed Can avoid recurrence of kidney transplantation

Pulmonary hemorrhage prevention

Goodpasture syndrome can be fatal quickly. The causes of death are usually pulmonary hemorrhage and respiratory failure. In the acute phase, tracheal intubation, assisted ventilation and hemodialysis are often required. Subsequent management depends on the use of high-dose corticosteroids (methylprednisolone 7 ~ 15mg / kg daily, divided into intravenous injections), immunosuppressive cyclophosphamide and anti-glomerular basement membrane antibody in repeated hemodialysis elimination cycle. The course of immunosuppressive therapy varies greatly, and it may be possible in some patients It takes 12 to 18 months. Early comprehensive use of these measures can protect renal function, and long-term hemodialysis or kidney transplantation can be used for advanced renal disease. Many patients have respiratory infections before onset, and have repeated hemoptysis in the future. Most of them occur before kidney disease. The elderly are several years old (up to 12 years) and the short ones are several months. Most patients with shorter durations die of hemoptysis, respiratory failure, or uremia. Pulmonary hemorrhage can be ignored because it is mild, and it can be life-threatening because of seriousness. It starts with cough, shortness of breath, and hemoptysis, often accompanied by anemia, hematuria, and proteinuria. Pulmonary symptoms precede the kidneys.