Abstract
This report describes a patient who presented with unusually severe acute post-streptococcal glomerulonephritis with the development of extensive crescents and later tubular damage and interstitial inflammation. Immunofluorescence studies of an early biopsy specimen showed granular deposits of IgG and β1C in glomeruli and no tubular staining. A later biopsy specimen (28 wk) showed diffuse linear staining of tubular basement membranes, indicating in vivo bound anti-TBM antibodies. At this time the patient's serum IgG was shown by indirect immunofluorescence to react with normal tubular basement membranes. It is proposed that the initial renal disease somehow triggered the formation of anti-TBM antibodies which may have contributed to the progress of the disease.
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