Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지
DOI QR코드

DOI QR Code

Plasmaphresis therapy for pulmonary hemorrhage in a pediatric patient with IgA nephropathy

  • Yim, Dae-Kyoon (Department of Pediatrics, Samsung Medical Center) ;
  • Lee, Sang-Taek (Department of Pediatrics, Samsung Medical Center) ;
  • Cho, Heeyeon (Department of Pediatrics, Samsung Medical Center)
  • Received : 2014.01.17
  • Accepted : 2014.03.28
  • Published : 2015.10.15
Download PDF
⟨ Previous Next ⟩

Abstract

IgA nephropathy usually presents as asymptomatic microscopic hematuria or proteinuria or episodic gross hematuria after upper respiratory infection. It is an uncommon cause of end-stage renal failure in childhood. Pulmonary hemorrhage associated with IgA nephropathy is an unusual life-threatening manifestation in pediatric patients and is usually treated with aggressive immunosuppression. Pulmonary hemorrhage and renal failure usually occur concurrently, and the pulmonary manifestation is believed to be caused by the same immune process. We present the case of a 14-year-old patient with IgA nephropathy who had already progressed to end-stage renal failure in spite of immunosuppression and presented with pulmonary hemorrhage during oral prednisone treatment. His lung disease was comparable to diffuse alveolar hemorrhage and was successfully treated with plasmapheresis followed by oral prednisone. This case suggests that pulmonary hemorrhage may develop independently of renal manifestation, and that plasmapheresis should be considered as adjunctive therapy to immunosuppressive medication for treating IgA nephropathy with pulmonary hemorrhage.

Keywords

References

  1. West SC, Arulkumaran N, Ind PW, Pusey CD. Pulmonary-renal syndrome: a life threatening but treatable condition. Postgrad Med J 2013;89:274-83. https://doi.org/10.1136/postgradmedj-2012-131416
  2. Afessa B, Cowart RG, Koenig SM. Alveolar hemorrhage in IgA nephropathy treated with plasmapheresis. South Med J 1997;90:237-9. https://doi.org/10.1097/00007611-199702000-00016
  3. Anantham D, Chan KP, Chuah KL, Vathsala A, Eng P. Pulmonary capillaritis in IgA nephropathy. South Med J 2007;100:605-7. https://doi.org/10.1097/SMJ.0b013e31804853dc
  4. Fung M, Churchill D, Alexopoulou I, Ingram A. IgA nephropathy and pulmonary hemorrhage in an adult. Am J Nephrol 2001;21: 318-22. https://doi.org/10.1159/000046268
  5. Lai FM, Li EK, Suen MW, Lui SF, Li PK, Lai KN. Pulmonary hemorrhage: a fatal manifestation in IgA nephropathy. Arch Pathol Lab Med 1994;118:542-6.
  6. Medcalf JF, Brownjohn AM, Turney JH. Pulmonary haemorrhage in association with IgA nephropathy. Nephrol Dial Transplant 1996;11:1148-9. https://doi.org/10.1093/oxfordjournals.ndt.a027473
  7. Yum MN, Lampton LM, Bloom PM, Edwards JL. Asymptomatic IgA nephropathy associated with pulmonary hemosiderosis. Am J Med 1978;64:1056-60. https://doi.org/10.1016/0002-9343(78)90461-8
  8. Srivaths P, Dishop MK, Elidemir O, Eldin K, Browne L, Elenberg E. IgA nephropathy presenting with renal failure and pulmonary hemorrhage. Pediatr Nephrol 2010;25:535-8. https://doi.org/10.1007/s00467-009-1382-8
  9. Mccaughey WT, Thomas BJ. Pulmonary hemorrhage and glomerulonephritis. The relation of pulmonary hemorrhage to certain types of glomerular lesions. Am J Clin Pathol 1962;38:577-89. https://doi.org/10.1093/ajcp/38.6.577
  10. Lee RW, D'Cruz DP. Pulmonary renal vasculitis syndromes. Autoimmun Rev 2010;9:657-60. https://doi.org/10.1016/j.autrev.2010.05.012

Cited by

  1. Therapeutic Plasma Exchange in Pediatric Kidney Disease: 23-year Experience at the Severance Children's Hospital in Korea vol.21, pp.2, 2015, https://doi.org/10.3339/jkspn.2017.21.2.81