Diffuse alveolar hemorrhage is encountered uncommonly, but it is useful to have a general understanding of this. Many etiologies can cause diffuse alveolar hemorrhage, with pulmonary vasculitis being perhaps the most widely feared. This chapter explores how to sift through the differential diagnosis of diffuse alveolar hemorrhage and, if vasculitis is suspected, how to initiate therapy for this.
Putting a moratorium on discussing #Pexivas in any setting (especially #SoMe) until paper is published….
🚨 #PexivasPolice 🚨 will fine you
— Matthew Sparks, MD, FASN, FAHA (@Nephro_Sparks) April 11, 2019
This chapter may also serve as a public protest for the ridiculous amount of time that it's taking the PEXIVAS trial to reach press. The abstract was released nearly a year ago. This might stir up the ire of the Pexivas Police (see above), but seriously… if there is a journal out there somewhere sitting on this study – please publish it already. Or just release a preliminary version electronically. Excessive publications delays are unethical as this impairs patient care.
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The IBCC chapter is located here.
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Great post Dr Farkas, but needs to be updated now that PEXIVAS has now been published Feb 2020: https://www.nejm.org/doi/10.1056/NEJMoa1803537
They found that there was no significant difference in primary outcome of ESKD/death (HR 0.86 CI 0.65-1.13) (Table 2, Figure 1) or secondary outcomes (Table 3). Patients who had haemorrhage had a larger reduction in risk of primary outcome (0.64, 0.67) than those without haemorrhage (0.95) but these were non-significant (Figure S3). In keeping with the conclusions from the previously-published abstract, unless you *strongly* believed in PLEX for haemorrhaging ANCA-vasculitis.
NephJC discussion of the article here: http://www.nephjc.com/news/pexivas