[Antiglomerular basement membrane antibody-mediated nephritis: incidence and morphological appearance in biopsy materials]

Abstract

A glomerulonephritis (GN) of the basement membrane antibody-mediated type was diagnosed in 51 patients (44 men, 7 women) on the basis of immunohistological findings in renal biopsy material in a period of 15 years. This represented about 5% of the cases in which immunohistologic studies gave evidence of glomerular disease. Young men, about 20 years old, were especially affected: 35 patients were men between ages 16 and 25 (69%). In about half the cases there were also pulmonary manifestations (Goodpasture's syndrome). In 63% of the cases there was extracapillary GN with compression and/or marked destruction of the glomerular tuft. Anti-glomerular basement membrane antibody-mediated nephritis was the most frequent cause of a rapidly progressive extracapillary GN in our sample. The broad use of renal biopsy in Goodpasture's syndrome has demonstrated that the morphologic spectrum of renal manifestations is much wider than originally believed. It ranges from normal or minimal findings and mild mesangioproliferative or focal extracapillary GN to severe diffuse extracapillary GN. The rapidly progressive form of extracapillary GN was not significantly more frequent in Goodpasture's syndrome than in the cases of GN without lung findings (62%). Immunohistologic findings apparently can persist unchanged for months and therefore microscopic examinations do not allow reliable conclusions concerning the natural history of immunologic activity in this process to be drawn.