PULMONARY HEMORRHAGE - A FATAL MANIFESTATION IN IGA NEPHROPATHY

Two patients with asymptomatic IgA nephropathy (IgAN) and a third pati ent with chronic renal failure due to IgAN died following a recent ons et of dyspnea, hemoptysis, and pulmonary infiltrates. In all cases, th e cause of death was respiratory failure attributed to either bronchop neumonia or pulmonary edema, However, no infectious agent was identifi ed. In all three patients, the diagnoses of IgAN and idiopathic pulmon ary hemorrhage were established at postmortem examination. Acute alveo lar hemorrhage was present in two patients. All three patients had hea vy alveolar hemosiderin-laden macrophages, and capillaritis was recogn ized in two of them. The occurrence of fatal pulmonary hemorrhage in p atients with IgAN is rare. Our findings suggested an immune complex-me diated pulmonary injury that was possibly related to the systemic natu re of IgAN.