[79-year-old patient with pulmorenal syndrome].

HISTORY AND ADMISSION FINDINGS

A 79-year-old female patient was referred with acute renal failure requiring haemodialysis and haemoptysis.

INVESTIGATIONS

Kidney biopsy showed extracapillary proliferative glomerulonephritis with crescents in 7 from 15 glomeruli and sclerosis in the remaining. A computed tomography scan of the chest showed evidence of alveolar haemorrhage. Serologic testing revealed autoantibodies against the glomerular basement membrane (anti-GBM antibodies) and myeloperoxidase antineutrophil cytoplasmic antibodies (MPO-ANCA).

DIAGNOSIS, TREATMENT AND COURSE: The patient was diagnosed with goodpasture's disease and underwent immunosuppressive therapy including prednisolone, cyclophosphamide pulses and plasmapheresis, resulting in clearance of anti-GBM antibodies and discontinuation of haemoptysis. Renal function, however, did not recover and the patient remained on dialysis.

CONCLUSIONS

Aggressive treatment including cyclophosphamide and plasma separation often ensures patient survival in goodpasture's disease, in most cases, however, renal function does not recover.