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

Ossman, Rime; Buob, David; Hellmark, Thomas LU ; 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
organization
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type
Contribution to journal
publication status
published
subject
in
Medicine
volume
95
issue
19
publisher
Lippincott Williams & Wilkins
external identifiers
  • Scopus:84969922154
  • WOS:000376927000071
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
2017-01-01 08:26:53
@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>},
  articleno    = {e3654},
  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    = {Lippincott Williams & Wilkins},
  series       = {Medicine},
  title        = {Factors Associated With Pathogenicity of Anti-Glomerular Basal Membrane Antibodies : A Case Report},
  url          = {http://dx.doi.org/10.1097/MD.0000000000003654},
  volume       = {95},
  year         = {2016},
}