Diffuse Alveolar Haemorrhage in ANCA-associated Vasculitis
Diffuse alveolar haemorrhage (DAH) is a serious complication of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). A literature review was performed to ascertain the diagnostic features, treatment, and outcome of this rare but serious condition. Haemoptysis and dyspnoea are com...
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| Veröffentlicht in: | Internal Medicine 2013, Vol.52(1), pp.5-13 |
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| creator | West, Stephen Arulkumaran, Nishkantha Ind, Phillip W. Pusey, Charles D. |
| description | Diffuse alveolar haemorrhage (DAH) is a serious complication of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). A literature review was performed to ascertain the diagnostic features, treatment, and outcome of this rare but serious condition. Haemoptysis and dyspnoea are common but non-specific features. Chest radiography is usually abnormal, and high-resolution computerised tomographic scanning is more sensitive. Increased uptake of inhaled carbon monoxide and reduced clearance of C15O on lung function testing is suggestive of intra-alveolar blood. Fiberoptic bronchoscopy and bronchoalveolar lavage are useful when a super-added infection is suspected. Concurrent renal disease is common and contributes to the morbidity and mortality. Treatment should be individualised, and it is based on glucocorticoid and cyclophosphamide induction with azathioprine maintenance. The role of plasmapheresis is unclear, and is currently being evaluated. Patients are at risk of disease and treatment-related long-term complications. Ongoing research into the most efficacious therapeutic regimens associated with the least side effects is especially important. |
| doi_str_mv | 10.2169/internalmedicine.52.8863 |
| format | Article |
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A literature review was performed to ascertain the diagnostic features, treatment, and outcome of this rare but serious condition. Haemoptysis and dyspnoea are common but non-specific features. Chest radiography is usually abnormal, and high-resolution computerised tomographic scanning is more sensitive. Increased uptake of inhaled carbon monoxide and reduced clearance of C15O on lung function testing is suggestive of intra-alveolar blood. Fiberoptic bronchoscopy and bronchoalveolar lavage are useful when a super-added infection is suspected. Concurrent renal disease is common and contributes to the morbidity and mortality. Treatment should be individualised, and it is based on glucocorticoid and cyclophosphamide induction with azathioprine maintenance. The role of plasmapheresis is unclear, and is currently being evaluated. Patients are at risk of disease and treatment-related long-term complications. Ongoing research into the most efficacious therapeutic regimens associated with the least side effects is especially important.</description><identifier>ISSN: 0918-2918</identifier><identifier>EISSN: 1349-7235</identifier><identifier>DOI: 10.2169/internalmedicine.52.8863</identifier><identifier>PMID: 23291668</identifier><language>eng</language><publisher>Japan: The Japanese Society of Internal Medicine</publisher><subject>Adrenal Cortex Hormones - therapeutic use ; alveolar haemorrhage ; ANCA ; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - complications ; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - diagnosis ; Bronchial Diseases - etiology ; Bronchial Diseases - mortality ; Bronchial Diseases - therapy ; Cause of Death ; Combined Modality Therapy ; Disease Progression ; Female ; Hemoptysis - etiology ; Hemoptysis - mortality ; Hemoptysis - therapy ; Hemorrhage - etiology ; Hemorrhage - mortality ; Hemorrhage - therapy ; Humans ; Male ; Plasmapheresis ; Prognosis ; Pulmonary Alveoli - pathology ; Recurrence ; Risk Assessment ; Severity of Illness Index ; Survival Rate ; vasculitis</subject><ispartof>Internal Medicine, 2013, Vol.52(1), pp.5-13</ispartof><rights>2013 by The Japanese Society of Internal Medicine</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c526t-db398d7f64cc15ea0b049b42d9d993b17809d2edbf9c6401995c8676c3015f0f3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,1883,4024,27923,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23291668$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>West, Stephen</creatorcontrib><creatorcontrib>Arulkumaran, Nishkantha</creatorcontrib><creatorcontrib>Ind, Phillip W.</creatorcontrib><creatorcontrib>Pusey, Charles D.</creatorcontrib><title>Diffuse Alveolar Haemorrhage in ANCA-associated Vasculitis</title><title>Internal Medicine</title><addtitle>Intern. Med.</addtitle><description>Diffuse alveolar haemorrhage (DAH) is a serious complication of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). A literature review was performed to ascertain the diagnostic features, treatment, and outcome of this rare but serious condition. Haemoptysis and dyspnoea are common but non-specific features. Chest radiography is usually abnormal, and high-resolution computerised tomographic scanning is more sensitive. Increased uptake of inhaled carbon monoxide and reduced clearance of C15O on lung function testing is suggestive of intra-alveolar blood. Fiberoptic bronchoscopy and bronchoalveolar lavage are useful when a super-added infection is suspected. Concurrent renal disease is common and contributes to the morbidity and mortality. Treatment should be individualised, and it is based on glucocorticoid and cyclophosphamide induction with azathioprine maintenance. The role of plasmapheresis is unclear, and is currently being evaluated. Patients are at risk of disease and treatment-related long-term complications. Ongoing research into the most efficacious therapeutic regimens associated with the least side effects is especially important.</description><subject>Adrenal Cortex Hormones - therapeutic use</subject><subject>alveolar haemorrhage</subject><subject>ANCA</subject><subject>Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - complications</subject><subject>Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - diagnosis</subject><subject>Bronchial Diseases - etiology</subject><subject>Bronchial Diseases - mortality</subject><subject>Bronchial Diseases - therapy</subject><subject>Cause of Death</subject><subject>Combined Modality Therapy</subject><subject>Disease Progression</subject><subject>Female</subject><subject>Hemoptysis - etiology</subject><subject>Hemoptysis - mortality</subject><subject>Hemoptysis - therapy</subject><subject>Hemorrhage - etiology</subject><subject>Hemorrhage - mortality</subject><subject>Hemorrhage - therapy</subject><subject>Humans</subject><subject>Male</subject><subject>Plasmapheresis</subject><subject>Prognosis</subject><subject>Pulmonary Alveoli - pathology</subject><subject>Recurrence</subject><subject>Risk Assessment</subject><subject>Severity of Illness Index</subject><subject>Survival Rate</subject><subject>vasculitis</subject><issn>0918-2918</issn><issn>1349-7235</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNptkMtOwzAQRS0EoqXwCyhLNil-xI7NriqPIlVlA2wtx55QV3kUO0Hi70nV0gViMyPNnJkrHYQSgqeUCHXrmw5CY6oanLe-gSmnUykFO0FjwjKV5pTxUzTGisiUDmWELmLcYMxkrug5GlE2TIWQY3R378uyj5DMqi9oKxOShYG6DWFtPiDxTTJbzWepibG13nTgkncTbV_5zsdLdFaaKsLVoU_Q2-PD63yRLl-enuezZWo5FV3qCqaky0uRWUs4GFzgTBUZdcopxQqSS6wcBVeUyooME6W4lSIXlmHCS1yyCbrZ_92G9rOH2OnaRwtVZRpo-6gJzRnlTBA-oHKP2tDGGKDU2-BrE741wXpnTv81pznVO3PD6fUhpS-G5fHwV9UArPbAJnaDmyNgQudtBf9-JrtySDiCdm2Chob9AI7Ti3Q</recordid><startdate>2013</startdate><enddate>2013</enddate><creator>West, Stephen</creator><creator>Arulkumaran, Nishkantha</creator><creator>Ind, Phillip W.</creator><creator>Pusey, Charles D.</creator><general>The Japanese Society of Internal Medicine</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>2013</creationdate><title>Diffuse Alveolar Haemorrhage in ANCA-associated Vasculitis</title><author>West, Stephen ; Arulkumaran, Nishkantha ; Ind, Phillip W. ; Pusey, Charles D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c526t-db398d7f64cc15ea0b049b42d9d993b17809d2edbf9c6401995c8676c3015f0f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adrenal Cortex Hormones - therapeutic use</topic><topic>alveolar haemorrhage</topic><topic>ANCA</topic><topic>Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - complications</topic><topic>Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - diagnosis</topic><topic>Bronchial Diseases - etiology</topic><topic>Bronchial Diseases - mortality</topic><topic>Bronchial Diseases - therapy</topic><topic>Cause of Death</topic><topic>Combined Modality Therapy</topic><topic>Disease Progression</topic><topic>Female</topic><topic>Hemoptysis - etiology</topic><topic>Hemoptysis - mortality</topic><topic>Hemoptysis - therapy</topic><topic>Hemorrhage - etiology</topic><topic>Hemorrhage - mortality</topic><topic>Hemorrhage - therapy</topic><topic>Humans</topic><topic>Male</topic><topic>Plasmapheresis</topic><topic>Prognosis</topic><topic>Pulmonary Alveoli - pathology</topic><topic>Recurrence</topic><topic>Risk Assessment</topic><topic>Severity of Illness Index</topic><topic>Survival Rate</topic><topic>vasculitis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>West, Stephen</creatorcontrib><creatorcontrib>Arulkumaran, Nishkantha</creatorcontrib><creatorcontrib>Ind, Phillip W.</creatorcontrib><creatorcontrib>Pusey, Charles D.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Internal Medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>West, Stephen</au><au>Arulkumaran, Nishkantha</au><au>Ind, Phillip W.</au><au>Pusey, Charles D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Diffuse Alveolar Haemorrhage in ANCA-associated Vasculitis</atitle><jtitle>Internal Medicine</jtitle><addtitle>Intern. Med.</addtitle><date>2013</date><risdate>2013</risdate><volume>52</volume><issue>1</issue><spage>5</spage><epage>13</epage><pages>5-13</pages><issn>0918-2918</issn><eissn>1349-7235</eissn><abstract>Diffuse alveolar haemorrhage (DAH) is a serious complication of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). A literature review was performed to ascertain the diagnostic features, treatment, and outcome of this rare but serious condition. Haemoptysis and dyspnoea are common but non-specific features. Chest radiography is usually abnormal, and high-resolution computerised tomographic scanning is more sensitive. Increased uptake of inhaled carbon monoxide and reduced clearance of C15O on lung function testing is suggestive of intra-alveolar blood. Fiberoptic bronchoscopy and bronchoalveolar lavage are useful when a super-added infection is suspected. Concurrent renal disease is common and contributes to the morbidity and mortality. Treatment should be individualised, and it is based on glucocorticoid and cyclophosphamide induction with azathioprine maintenance. The role of plasmapheresis is unclear, and is currently being evaluated. Patients are at risk of disease and treatment-related long-term complications. Ongoing research into the most efficacious therapeutic regimens associated with the least side effects is especially important.</abstract><cop>Japan</cop><pub>The Japanese Society of Internal Medicine</pub><pmid>23291668</pmid><doi>10.2169/internalmedicine.52.8863</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| language | eng |
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| source | MEDLINE; J-STAGE (Japan Science & Technology Information Aggregator, Electronic) Freely Available Titles - Japanese |
| subjects | Adrenal Cortex Hormones - therapeutic use alveolar haemorrhage ANCA Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - complications Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - diagnosis Bronchial Diseases - etiology Bronchial Diseases - mortality Bronchial Diseases - therapy Cause of Death Combined Modality Therapy Disease Progression Female Hemoptysis - etiology Hemoptysis - mortality Hemoptysis - therapy Hemorrhage - etiology Hemorrhage - mortality Hemorrhage - therapy Humans Male Plasmapheresis Prognosis Pulmonary Alveoli - pathology Recurrence Risk Assessment Severity of Illness Index Survival Rate vasculitis |
| title | Diffuse Alveolar Haemorrhage in ANCA-associated Vasculitis |
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