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We received a 23-year-old male, working in the Army for 18 months, with advanced renal impairment, haemoptysis and hyperkalemia. An impression of the pulmonary renal syndrome was made and he was managed aggressively with haemodialysis, plasma exchange and pulsing with methyl prednisolone. His condition improved, but the renal functions did not. The vasculitic workup including Extractable Nuclear Antigen (ENA) and Anti-Neutrophil Cytoplasmic Antibody (ANCA) which were sent on admission came outdoi:10.4236/ojneph.2013.34031 fatcat:rbat7qqk3zga5jsv2ugilrndvi