Der Pneumologe

, Volume 7, Issue 6, pp 434–440

Das pulmorenale Syndrom auf der Intensivstation

Leitthema
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Zusammenfassung

Das pulmorenale Syndrom ist ein internistischer Notfall, der unbehandelt mit einer hohen Letalität einhergeht. Die häufigsten Ursachen sind die ANCA-assoziierten Vaskulitiden – unter diesen am häufigsten die Wegener-Granulomatose und die mikroskopische Polyangiitis – und das Goodpasture-Syndrom.

Nach primärer respiratorischer und hämodynamischer Stabilisierung der Patienten ist eine schnelle Diagnose unter Berücksichtigung vieler Differenzialdiagnosen wichtig, um unverzüglich eine adäquate Therapie einleiten zu können. Hilfreich sind hier neben einer gezielten Anamnese und Untersuchung die Bestimmung von Autoantikörpern sowie Bildgebung und Bronchoskopie, außerdem sollte eine Nierenbiopsie erfolgen. Der diagnostische Wert einer Lungenbiopsie ist bisher nicht belegt.

Die Therapie basiert im Wesentlichen auf einer aggressiven Immunsuppression und der Plasmapherese.

Schlüsselwörter

ANCA-assoziierte Vaskulitiden Kleingefäßvaskulitiden Goodpasture-Syndrom Proliferative Glomerulonephritis Alveoläre Hämorrhagie 

Pulmonary renal syndrome in the ICU

Abstract

Pulmonary renal syndrome is an emergency situation in internal medicine, associated with high mortality if not treated adequately. The underlying diseases include mainly the vasculitides associated with antineutrophil cytoplasmatic antibodies – among these mainly Wegener’s granulomatosis and microscopic polyangiitis – and Goodpasture’s syndrome.

After having stabilized the hemodynamic and respiratory status of the patient, it is of great importance to identify the underlying disease and exclude a variety of other diseases that can mimic a pulmonary renal syndrome. Besides taking a history and a complete physical examination, X-ray imaging, scanning for auto-immunologic antibodies and bronchoscopy have proved to be helpful for this purpose.

In addition, a renal biopsy should be performed if possible. Whether a biopsy of the lung is of further diagnostic value is unclear. Therapy is based on intense immunosuppression and plasmapheresis.

Keywords

ANCA-associated vasculitides Small-vessel vasculitides Goodpasture’s syndrome Proliferative glomerulonephritis Alveolar hemorrhage 

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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  1. 1.Nierenzentrum HeidelbergMedizinische Universitätsklinik HeidelbergHeidelbergDeutschland
  2. 2.Klinik für Pneumologie und GastroenterologieStädtisches Klinikum München-HarlachingMünchenDeutschland

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