DAH and UA

Q: 34 years old male is admitted to ICU with Diffuse Alveolar hemorrhage (DAH). Urinalysis (UA) should be sent.

A) True

B) False

Answer: A

It is important to rule out any associated pulmonary-renal syndromes particularly focal segmental necrotizing glomerulonephritis in any patient with DAH. This can be ruled out early in differential Diagnosis by normal UA. Abnormal UA may present as RBCs, WBCs, proteinuria, and/or red and white blood cell casts. Also, the serum chemistry profile is likely to show elevated plasma creatinine concentration.

#vasculitis

#pulmonary

#nephrology

#Differential-Diagnosis

References:

1. Boyle N, O'Callaghan M, Ataya A, Gupta N, Keane MP, Murphy DJ, McCarthy C. Pulmonary renal syndrome: a clinical review. Breathe (Sheff). 2022 Dec;18(4):220208. doi: 10.1183/20734735.0208-2022. Epub 2023 Jan 10. PMID: 36865943; PMCID: PMC9973488.

2. Saladi L, Shaikh D, Saad M, Cancio-Rodriguez E, D'Agati VD, Medvedovsky B, Uday KA, Adrish M. Pulmonary renal syndrome: A case report of diffuse alveolar hemorrhage in association with ANCA negative pauci-immune glomerulonephritis. Medicine (Baltimore). 2018 Jun;97(23):e10954. doi: 10.1097/MD.0000000000010954. PMID: 29879042; PMCID: PMC5999515.

3. Talwar D, Vadala R, Talwar S, Pahuja S, Prajapat D. Pulmonary-Renal Syndrome: A Real-World Experience From a Tertiary Care Pulmonary Center in North India. Cureus. 2022 Jan 17;14(1):e21327. doi: 10.7759/cureus.21327. PMID: 35186586; PMCID: PMC8849225.