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Factors Associated With Pathogenicity of Anti-Glomerular Basal Membrane Antibodies : A Case Report

Ossman, Rime ; Buob, David ; Hellmark, Thomas LU orcid ; Brocheriou, Isabelle ; Peltier, Julie ; Tamouza, Ryad ; Dahan, Karine ; Hertig, Alexandre ; Rondeau, Eric and Galichon, Pierre (2016) In Medicine 95(19).
Abstract

Antiglomerular basement membrane (GBM) disease is known as a super-acute proliferative glomerulonephritis caused by auto-antibodies targeting the NC1 domain of the α3 chain of type IV collagen.Here, we describe a case of atypical anti-GBM disease presenting as a dialysis-dependent acute renal failure with unusual mild glomerular involvement. We found that immunoglobulin G (IgG) deposits were restricted to the uncommon IgG2 and IgG4 subclasses, and that blood was positive for anti-GBM antibodies by immunofluorescence, but not by Enzyme Linked Immunosorbent Assay (ELISA). The patient was treated with plasma exchanges, corticosteroids, and cyclosphosphamide. He eventually regained a normal renal function.This case demonstrates that... (More)

Antiglomerular basement membrane (GBM) disease is known as a super-acute proliferative glomerulonephritis caused by auto-antibodies targeting the NC1 domain of the α3 chain of type IV collagen.Here, we describe a case of atypical anti-GBM disease presenting as a dialysis-dependent acute renal failure with unusual mild glomerular involvement. We found that immunoglobulin G (IgG) deposits were restricted to the uncommon IgG2 and IgG4 subclasses, and that blood was positive for anti-GBM antibodies by immunofluorescence, but not by Enzyme Linked Immunosorbent Assay (ELISA). The patient was treated with plasma exchanges, corticosteroids, and cyclosphosphamide. He eventually regained a normal renal function.This case demonstrates that biopsy-proven anti-GBM disease can have reduced pathogenicity. Referring to previous studies of anti-GBM detection in the blood from healthy or minimally ill individuals, we discuss the antigenic specificities, the IgG subclasses, and the involvement of complement in this observation.We suggest that anti-GBM disease is a heterogeneous entity and that the study of IgG subclasses by immunofluorescence may help to distinguish categories with different severities.

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author
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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Medicine
volume
95
issue
19
article number
e3654
publisher
Wolters Kluwer
external identifiers
  • scopus:84969922154
  • wos:000376927000071
  • pmid:27175692
ISSN
1536-5964
DOI
10.1097/MD.0000000000003654
language
English
LU publication?
yes
id
cdef9221-dcc0-4c88-9e4a-39c0ddda948b
date added to LUP
2016-05-23 15:39:25
date last changed
2025-01-12 03:04:08
@article{cdef9221-dcc0-4c88-9e4a-39c0ddda948b,
  abstract     = {{<p>Antiglomerular basement membrane (GBM) disease is known as a super-acute proliferative glomerulonephritis caused by auto-antibodies targeting the NC1 domain of the α3 chain of type IV collagen.Here, we describe a case of atypical anti-GBM disease presenting as a dialysis-dependent acute renal failure with unusual mild glomerular involvement. We found that immunoglobulin G (IgG) deposits were restricted to the uncommon IgG2 and IgG4 subclasses, and that blood was positive for anti-GBM antibodies by immunofluorescence, but not by Enzyme Linked Immunosorbent Assay (ELISA). The patient was treated with plasma exchanges, corticosteroids, and cyclosphosphamide. He eventually regained a normal renal function.This case demonstrates that biopsy-proven anti-GBM disease can have reduced pathogenicity. Referring to previous studies of anti-GBM detection in the blood from healthy or minimally ill individuals, we discuss the antigenic specificities, the IgG subclasses, and the involvement of complement in this observation.We suggest that anti-GBM disease is a heterogeneous entity and that the study of IgG subclasses by immunofluorescence may help to distinguish categories with different severities.</p>}},
  author       = {{Ossman, Rime and Buob, David and Hellmark, Thomas and Brocheriou, Isabelle and Peltier, Julie and Tamouza, Ryad and Dahan, Karine and Hertig, Alexandre and Rondeau, Eric and Galichon, Pierre}},
  issn         = {{1536-5964}},
  language     = {{eng}},
  number       = {{19}},
  publisher    = {{Wolters Kluwer}},
  series       = {{Medicine}},
  title        = {{Factors Associated With Pathogenicity of Anti-Glomerular Basal Membrane Antibodies : A Case Report}},
  url          = {{https://lup.lub.lu.se/search/files/13136561/8025228.pdf}},
  doi          = {{10.1097/MD.0000000000003654}},
  volume       = {{95}},
  year         = {{2016}},
}