Goodpasture syndrome. Dissociation from antibodies to glomerular basement membrane.

Abstract

Immunologic studies of patients with Goodpasture syndrome have demonstrated antibodies to glomerular basement membrane in glomeruli and serum.1,2Using immunofluorescent techniques, investigators have identified linearly deposited immunoglobulin G (IgG) along these membranes.3,4In addition, serum and eluates of kidneys of these patients cross-react with alveolar basement membranes.5,6Such observations suggest that antibodies may mediate both pulmonary hemorrhage and glomerulonephritis in patients with Goodpasture syndrome. Studies of kidney disease produced by heterologous antilung antibodies support this hypothesis.7-9Nevertheless, direct evidence that antibodies to alveolar basement membranes cause pulmonary hemorrhage in Goodpasture syndrome is lacking. We describe a patient with typical clinical and histologic abnormalities of Goodpasture syndrome, but with granular deposits of IgG and β1C-globulin on kidney basement membranes. Our observations illustrate that antibodies to glomerular basement membrane do not exclusively cause the glomerulitis of Goodpasture syndrome. Patient Summary A 16-year-old boy was admitted to