Pneumotox » Drug » Hemodialysis - Chronic renal replacement therapy

Hemodialysis - Chronic renal replacement therapy

Respiratory manifestations are manifold. They may occur with the hemodialysis session (e.g. anaphylaxis), or as a complication of longterm renal replacement therapy. Review at PMID 18261549

Last update : 25/03/2016

I.c Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)

I.g Pulmonary fibrosis

I.i Diffuse pulmonary calcification (calciphylaxis)

II.f Hypoxemia, low oxygen saturation (may occur in isolation)

II.h Overload pulmonary edema (including posttransfusional (TACO))

V.a Pleural effusion (uni- or bilateral) (can accompany DI-LDs)

V.c Pleural thickening

VI.a Pulmonary embolism - Venous thrombosis/thromboembolism

VI.b Pulmonary arterial hypertension

VI.o Air/gas embolism

X.f Anaphylaxis-Anaphylactoid reaction (can be fatal)

Diagnosing DIRD

Drug and radiation history

Drug singularity - Correct identification of the drug

Consistent timing of exposure v. onset of symptoms

Clinical, imaging, BAL, pathological pattern consistent with the specific drug

Careful exlusion of another cause

Remission of symptoms with removal of drug

Recurrence with rechallenge (rarely advisable)

Causality assessment

More detailed checklist

The Drug-Induced Respiratory Disease Website

Philippe Camus, M.D.

Dijon, France