A challenging case of pneumo-renal syndrome (Nephrology Zebras)
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ART IN THE WARD
A challenging case of pneumo‑renal syndrome (Nephrology Zebras) Aghilès Hamroun1,2 · Victor Fages1 · Bouleau Julien3 · Rémi Lenain1 · Marie Frimat1,4 Received: 9 September 2020 / Accepted: 10 October 2020 © Italian Society of Nephrology 2020
Keywords Pneumo-renal syndrome · Acute kidney failure · Hantavirus · Nephropathia epidemica · Hemorrhagic fever with renal syndrome
Introduction Pneumo-renal syndrome is an entity grouping together all etiologies resulting in concomitant acute renal failure and pulmonary involvement, most often represented by intraalveolar hemorrhage [1]. In 70–90% of cases, the underlying etiology is systemic vasculitis, related to antineutrophil cytoplasmic (ANCA) or anti-glomerular basal membrane (anti-GBM) antibodies. However, there are multiple etiologies responsible for pneumo-renal syndrome, such as nonANCA/non-anti-GBM antibody-mediated vasculitis (mainly Henoch-Schönlein purpura, mixed cryoglobulinemia, or IgA nephropathy), autoimmune rheumatic diseases (systemic lupus erythematosus, scleroderma, or rheumatoid arthritis) and more rarely, thrombotic microangiopathies (due to antiphospholipid syndrome, thrombotic thrombocytopenia, infections, or neoplasm). Given the seriousness of pneumorenal syndrome, being able to make an accurate diagnosis is crucial, as it can drastically impact the patient’s management and prognosis [1, 2]. However, given the wide variety of
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40620-020-00889-9) contains supplementary material, which is available to authorized users. * Aghilès Hamroun [email protected] 1
Nephrology Transplantation and Dialysis Department, University of Lille, CHRU Lille, Rue Michel Polonovski, 59000 Lille, France
2
INSERM U1018, CESP, Clinical Epidemiology Team, Villejuif, France
3
Ophthalmology Department, University of Lille, CHRU Lille, 59000 Lille, France
4
U995‑Lille Inflammation Research International Center, INSERM, CHU Lille, University of Lille, Lille, France
differential diagnoses and severity of clinical presentation, the diagnostic approach may prove difficult in practice [1, 3].
Case description A 32-year-old man, current smoker but with no medical or surgical history, was hospitalized for febrile hypoxemic pneumonia and treated with cefotaxime/spiramycin and oxygen therapy (3L/min) over 2 days. He developed acute renal failure associated with low blood pressure (100/70 mmHg), oliguria, intense abdominal pain, headaches and badly blurred vision, and was referred to our nephrology and intensive care department. When carrying out the initial physical examination, we found out that he was a regular hunter in the Ardennes forest, and had been on a hunting trip ten days before. On admission, serum creatinine was 528 μmol/L (baseline creatinine: 89 μmol/L 6 months earlier) and reached 1100 μmol/L at day 6. His 24 h-proteinuria was 6.3 g (including 2.4 g/24 h of albuminuria) and urinalysis showed isolated microscopic hematuria with 4
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