A CASE OF RENAL FAILURE AS INITIAL PRESENTATION OF ANTINEUTROPHIL CYTOPLASMIC ANTIBODIES-ASSOCIATED VASCULITIS

TOPIC: Pulmonary Manifestations of Systemic Disease TYPE: Fellow Case Reports INTRODUCTION: Antineutrophil cytoplasmic antibodies – associated vasculitis (AAVs) are a rare group diseases that primarily affect small vessels. If left untreated, they can lead to significant morbidity and mortality. We present case diffuse alveolar hemorrhage (DAH) in patient with recently diagnosed end stage renal disease (ESRD). CASE PRESENTATION: A 57 year old man past medical history hypertension was ESRD 2 months prior. He presented dyspnea worsening over the 24 hours. had been evaluated emergency room (ER) days ago after being sent from his dialysis center for severe anemia (Hb 5.3 g/dL). denied any other symptoms including hemoptysis or melena. received blood transfusion 3 units, but he declined admission further workup ER. On exam, tachypneic SaO2 86% on air. BiPAP initiated decrease work breathing. Computerized tomography (CT) chest showed extensive ground glass opacities subpleural sparing emphysematous changes. Bronchoscopy revealed progressively bloody aliquots fluid, cytology hemosiderin-laden macrophages, consistent DAH. Additional laboratory data remarkable lactic acid (10.3 mMol/L), (hemoglobin 6.2 g/dL), positive anti-nuclear (1:40), P-ANCA (1:640) MPO (329). Treatment antibiotics high dose steroids AAV started resulted clinical improvement. Retrospective review at time failure urinalysis both hematuria (>182 RBC/HPF) proteinuria (>500 mg/dL). DISCUSSION: may multiple organ systems. In majority patients AAV, dysfunction be part syndrome it also sole manifestation. Renal function presentation has direct correlation risk progression Often diagnosis delayed due mimickers disease. Unexplained should raise concern AAV. Early identification treatment steroid regimens combination immunosuppressive drugs achieve remission. Our pulmonary involvement, injury preceded CONCLUSIONS: highlights importance detailed thorough investigation those unexplained failure, emphasizes involvement sequential not simultaneous. REFERENCE #1: Yates M, Watts RA, Bajema IM, et al EULAR/ERA-EDTA recommendations management ANCA-associated vasculitis, Annals Rheumatic Diseases 2016;75:1583-1594 #2: Wallace Z S, Miloslavsky E M. Management ANCA BMJ 2020; 368 :m421 doi:10.1136/bmj.m421 #3: Geetha D, Jin Q, Scott J, al. Comparisons Guidelines Recommendations Managing Cytoplasmic Antibody-Associated Vasculitis. Kidney Int Rep. 2018;3(5):1039-1049. Published 2018 May 24. doi:10.1016/j.ekir.2018.05.007 DISCLOSURES: No relevant relationships by Andres Escobar, source=Web Response Saadia Faiz, Isabel Mira-Avendano,