SHM Converge Scientific Abstract ePoster Gallery-Stepping Stones: Pulmonary-Renal Syndrome Masked by Nephrolithiasis

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This case describes a 76-year-old woman whose pulmonary-renal syndrome (PRS) was initially missed because her hematuria was attributed to bilateral nephrolithiasis. She first presented with right flank pain, painless hematuria, anemia, and acute kidney injury, but urinalysis showed significant blood and protein without casts, and CT revealed renal stones without obstruction. She was discharged for outpatient urology and nephrology follow-up.<br /><br />Two weeks later, she returned with severe shortness of breath and hypoxia. Examination showed conjunctival pallor and bilateral crackles, and chest imaging demonstrated diffuse bilateral airspace infiltrates consistent with diffuse alveolar hemorrhage. Despite treatment with broad-spectrum antibiotics and diuresis, her respiratory status worsened. Further workup revealed MPO-ANCA positivity, and she was started on high-dose steroids and rituximab. Renal biopsy confirmed crescentic glomerulonephritis, establishing the diagnosis of PRS.<br /><br />Her hospital course was prolonged and complicated by the need for continuous renal replacement therapy, but she ultimately recovered renal function and was discharged home after three months.<br /><br />The report highlights that PRS is defined by the combination of rapidly progressive glomerulonephritis and diffuse alveolar hemorrhage, most commonly due to ANCA-associated vasculitis or anti-GBM disease. In this patient, diagnosis was delayed because nephrolithiasis seemed to explain the hematuria and her age lowered suspicion for vasculitis. The case emphasizes the need to maintain a broad differential for hematuria and acute kidney injury, and to involve pulmonary, nephrology, rheumatology, and critical care teams early when PRS is suspected.

Asset Subtitle

Harleen K. Sidhu

Meta Tag

Author List Alberto Busmail Haylock, Aparna Rathnam, Harleen K. Sidhu, Rahul Nair, Thanushiree Sivalingam

Category Clinical Vignettes

Concept Pulmonary-Renal Syndrome

Concept Rapidly Progressive Glomerulonephritis

Concept Diffuse Alveolar Hemorrhage

Concept ANCA-Associated Vasculitis

Concept Anti-GBM Disease

Distinguished Non-Finalist

Presenter Organization Department of Medicine, NYC Health + Hospitals/Elmhurst, Icahn School of Medicine at Mount Sinai

Presenting Author Harleen K. Sidhu

Track Adult

Keywords

pulmonary-renal syndrome

diffuse alveolar hemorrhage

MPO-ANCA

crescentic glomerulonephritis

acute kidney injury

hematuria

nephrolithiasis

ANCA-associated vasculitis

rituximab

renal biopsy

Pulmonary-Renal Syndrome

Rapidly Progressive Glomerulonephritis

Diffuse Alveolar Hemorrhage

ANCA-Associated Vasculitis

Anti-GBM Disease