What is Pulmonary Renal Syndrome?

Pulmonary Renal syndrome (PRS), in a simple language, can be understood as a condition that affects both lungs and kidneys. It is not a disease per se, but a condition that results due to multiple autoimmune diseases. Auto-immune diseases are those where our body’s own cells of immunity attack tissues and organs of it’s own. PRS is a medical emergency that needs prompt diagnosis and rigorous management in the I.C.U.

What are the conditions that cause PRS?

Diseases that cause Pulmonary Renal Syndrome can be characterized as:

1. Connective Tissue Disorders: Polymyositis or Dermatomyositis (Conditions in which the muscles or skin get inflamed), Rheumatoid Arthritis (Disease in which the joints become painful or deformed), Systemic Lupus Erythematosus (A Chronic Inflammatory Condition).
2. Goodpasture Syndrome: A raredisease which can involve lung disease and a quickly worsening kidney.
3. Systemic Vasculitis: Behçet Syndrome, Churg-Strauss Syndrome, Microscopic Polyarteritis and Granulomatosis with Polyangiitis (Diseases in which there is inflammation of blood vessels)
4. Renal Disorders: Idiopathic Immune Complex Glomerulonephritis, IgA Nephropathy, Rapidly Progressive Glomerulonephritis with Heart Failure (Diseases in which the glomerulus of the kidney is damaged. The glomerulus is a bunch of small blood vessels around the end of a kidney tubule.)

What goes wrong?

The chief areas of affection in Pulmonary Renal Syndrome are:

a) Blood vessels, capillaries and alveoli of the lung: Alveoli are the units in the lung which are responsible for exchange of gases and purifying blood. Antibodies attack these units along with the blood vessels and capillaries causing bleeding. In medical terminology it is referred to as diffuse alveolar hemorrhage.

b) Glomerular apparatus: Glomerules are the filtration units in the kidney. They play a major role in filtration of blood and formation of urine. They help to retain the proteins and salts required by the body and flush out the waste products. In PRS, antibodies attack these units resulting in a condition called as focal segmental proliferative glomerulonephritis.

What are the signs and symptoms?

Kidneys and lungs could be affected together or weeks apart. Hence, the symptoms and signs that resurface indicate the malfunction of either the kidneys or the lungs or both. Some of the presenting symptoms are:

1. Breathlessness
2. Cough
3. Fever
4. Blood in sputum (hemoptysis)
5. Pink or cola-colored urine indicating blood in urine (hematuria)
6. Foamy urine indicating excess protein (proteinuria)
7. High Blood Pressure (hypertension)
8. Swelling in your face, hands, feet or abdomen.
9. Anemia or kidney failure resulting in tiredness.

How is Pulmonary Renal Syndrome diagnosed?

PRS is suspected when blood is present in sputum in absence of other conditions that are known to cause it. Mostly this is accompanied by findings suggestive of kidney disease.

Following steps are followed to diagnose and assess the extent of pathology:

1. The first step getting the urine tested. The presence of red cell casts indicate glomerulonephritis.
2. Serum creatinine is checked to assess the kidney functioning.
3. Routine CBC is done to check for anemia.
4. Antibodies in the blood can be tested to diagnose the causative disease such as Anti Glomerular basement membrane antibodies (for Goodpasture syndrome), Antibodies to dsDNA and reduced serum complement levels (for SLE), ANCA (for Granulomatosis with polyangiitis), ANCA to myeloperoxidase (for Microscopic polyangiitis)
5. A sample of tissue is taken from the Lung for findings of small-vessel vasculitis and Kidney for findings of glomerulonephritis to confirm the diagnosis of PRS (called Lung & Kidney Biopsy).

How is PRS treated?

The root cause of PRS is the imbalance in the immunity and the antibodies resulting from the same. Hence, the cornerstone of the treatment in modern medicine is to suppress the immunity in order to control the condition and treat the underlying disease. The most common drugs used for immunosuppression are corticosteroids and cyclophosphamide. Some cases may require plasma exchange.

After the life-threatening condition subsides, maintenance therapy with low dose corticosteroids and cytotoxic agents is continued for another 6 to 12 months. However, relapse may occur despite ongoing therapy.

Homoeopathy offers a supportive role in the treatment of Pulmonary Renal Syndrome in addition to conventional treatment. Contact us today to know how Homoeopathy can help your Pulmonary Renal Syndrome.