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Antiglomerular basement membrane (Goodpasture) disease

Last reviewed: 1 Nov 2024
Last updated: 20 Nov 2024

Summary

Definition

History and exam

Key diagnostic factors

  • reduced urine output
  • hemoptysis
  • edema
Full details

Other diagnostic factors

  • male gender
  • age 20 to 30 years or 60 to 70 years
  • shortness of breath
  • cough
  • fever
  • nausea
  • crackles on lung examination
Full details

Risk factors

  • HLA-DRB1 or DR4
  • smoking
  • exposure to hydrocarbons, organic solvents, heavy metals
  • history of lithotripsy
  • recent respiratory infections
  • immunotherapy
  • post-renal transplant in patients with Alport syndrome
Full details

Diagnostic tests

1st tests to order

  • renal function testing
  • renal biopsy
  • antiglomerular basement membrane (anti-GBM) antibody titer
  • antineutrophil cytoplasmic antibodies (ANCA)
  • serum complement (C3 and C4)
  • antinuclear antibody
  • cryoglobulins
  • hepatitis panel
  • antistreptolysin O titer
  • clotting screen
Full details

Treatment algorithm

INITIAL

suspected rapidly progressive glomerulonephritis

ACUTE

reversible renal disease or any pulmonary involvement

irreversible renal disease and no evidence of pulmonary involvement

ONGOING

unresponsive to initial treatment

Contributors

Authors

Tingting Li, MD, MSCI, FASN

Professor of Medicine

Director, Glomerular Diseases Program

Division of Nephrology

Washington University School of Medicine in St Louis

St Louis

MO

Disclosures

TL receives research support from Travere Therapeutics, Omeros Corporation, and the US NIH/NIAID, and reports consultancy agreements with ChemoCentryx, Travere Therapeutics, Amgen, Aurinia Pharmaceuticals, Calliditas Therapeutics, and GlaxoSmithKline. She also serves as a board member of GlomCon and a member of the ASN Publications Committee.

Christina Mariyam Joy, MD

Assistant Professor of Medicine

Division of Nephrology

Froedtert and Medical College of Wisconsin

Milwaukee

WI

Disclosures

CMJ declares that she has no competing interests.

Acknowledgements

Dr Tingting Li and Dr Christina Mariyam Joy would like to gratefully acknowledge Dr Richard G. Phelps, Professor Andre A. Kaplan and Dr Michael S. Gersch, previous contributors to this topic. RGP and MSG declare that they have no competing interests. AAK has received honoraria in 2013 to speak about plasma exchange from Gambro and Alexion (Gambro manufactures products for plasma exchange and Alexion manufactures a complement cascade inhibitor).

Peer reviewers

Dorin-Bogdan Borza, PhD

Assistant Professor of Medicine

Division of Nephrology

Department of Medicine

Vanderbilt University School of Medicine

Nashville

TN

Disclosures

DBB declares that she has no competing interests.

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