- Diffuse Alveolar Hemorrhage is caused by disruption of the alveolar-capillary basement membrane
- Diagnosed via progressively more hemorrhage after saline lavage on BAL (see image below!)
- Chest Xray in DAH is non-specific, there can be new patchy/diffuse opacities
- 33% DON’T have hemoptysis
- Classically, DAH presents as acute onset cough, dyspnea, and hemoptysis
- Causes
- 1) Vasculitis (MPA, GPA, Churg-Strauss)
- 2) Pulmonary Renal Syndromes: Goodpastures, IgA Nephropathy
- 3) Autoimmune: SLE, APLS
- 4) Meds: Amiodarone, cocaine, nitrofurantoin, anticoagulants
- Nephritic Syndromes: Rapidly progressive GN occurs among the nephritic syndromes (not nephrotic syndromes). The nephritic syndromes can be divided per the image below.
- c-anca more associated with Wegener, mpa and churg strauss more associated with p-anca, but significant overlap
- Wegeners a/w sinusitis and Churg-strauss associated with eosinophilia and asthma
- Pauci-Immune GN is called that because there are no immune deposits seen on immunofluoroscopy
SCVMC IM Chief Resident Blog 