リウマチ

Critical care 2007,11,213のレビューでは下記の鑑別診断リストが呈示されている。一方、NEJN 359;14,2008のClinical-problem-solvingでは、
Goodpasture症候群、SLE、Wegener肉芽腫症、顕微鏡的多発血管炎が挙げられている。
（症例の臨床症状によるが、混合型クリオグロブリン血症やTMA（血栓性微小血管障害）は鑑別診断にあげておいても良いと思われる）

Pulmonary –renal syndromes　　　　　　　　　　　　　　　　
(1) Pulmonary renal syndrome associated with anti-GBM antibodies: Goodpasture’s syndrome
(2) Pulmonary renal syndrome in ANCA-positive systemic vasculitis 　
　Wegener’s granulomatosis 　
　Microscopic polyangiitis 　
　Churg Strauss syndrome 　
　Other vasculitis
(3) Pulmonary renal syndrome in ANCA-negative systemic vasculitis 　
　Henoch Schönlein purpura 　
　Mixed cryoglobulinaemia 　
　Behçet’s disease 　
　IgA nephropathy
(4) ANCA-positive pulmonary renal syndrome without systemic vasculitis:
　　Idiopathic pulmonary renal syndrome 　
　Pauci-immune necrotic glomerulonephritis and pulmonary capillaritis
(5) Pulmonary renal syndrome in drug-associated ANCA-positive vasculitis 　
　Propylthiouracil 　
　D-Penicillamine 　
　Hydralazine 　
　Allopurinol 　
　Sulfasalazine
(6) Pulmonary renal syndrome in anti-GBM-postive and ANCA-positive patients
(7) Pulmonary renal syndrome in autoimmune rheumatic diseases (immune complexes and/or ANCA mediated) 　 　
　Systemic lupus erythematosus 　
　Scleroderma (ANCA?) 　
　Polymyositis 　
　Rheumatoid arthritis 　
　Mixed collagen vascular disease
(8) Pulmonary renal syndrome in thrombotic microangiopathy 　Antiphospholipid syndrome 　
　Thrombotic thrombocytopenic purpura 　
　Infections 　
　Neoplasms
(9) Diffuse alveolar haemorrhage complicating idiopathic pauci-immune glomerulonephritis

追加　
Pulmonary-Renal Vasculitic Disorders:
Differential Diagnosis and Management
(Current Rheumatology Reports 2003, 5:107–115)

表　Pulmonary-renal
syndrome (pulmonary hemorrhage and
glomerulonephritis)の分類
(1) Goodpasture's syndrome or antiglomerular basement
membranes
(2) Immune complex–induced
　Systemic lupus erythematosus
　Rheumatoid arthritis
　Systemic sclerosis
(3) Antineutrophil cytoplasmic antibody–associated vasculitis
　Microscopic polyangiitis
　Wegener's granulomatosis
　Churg-Strauss syndrome
　Drug-induced vasculitis
　Pauci-immune necrotizing and crescentic
glomerulonephritis
(4) Non–antineutrophil cytoplasmic antibody–associated vasculitis
　Henoch-Schönlein purpura
　Essential cryoglobulinemia
　Behçet's disease
　Immunoglobulin A nephropathy
(5) Antiphospholipid syndrome
(6) Others