Circulating anti-glomerular basement membrane antibodies with predominance of subclass IgG4 and false-negative immunoassay test results in anti-glomerular basement membrane disease
(2014) In American Journal of Kidney Diseases 63(2). p.93-289- Abstract
Autoantibodies against a constituent of the glomerular basement membrane (GBM), the α3-chain of type IV collagen, can cause both rapidly progressive glomerulonephritis and alveolar hemorrhage, referred to as anti-GBM disease or Goodpasture disease. Anti-GBM antibodies generally are of immunoglobulin G subclass 1 (IgG1) and can in most cases readily be detected in the circulation using enzyme-linked immunosorbent assays (ELISAs). We report 4 cases in which anti-GBM ELISA yielded negative or borderline results despite life-threatening disease. All 4 patients had positive results by IgG4 anti-GBM ELISA and all had undetectable antineutrophil cytoplasmic antibody. All cases were confirmed with kidney biopsy. Two of the patients showed... (More)
Autoantibodies against a constituent of the glomerular basement membrane (GBM), the α3-chain of type IV collagen, can cause both rapidly progressive glomerulonephritis and alveolar hemorrhage, referred to as anti-GBM disease or Goodpasture disease. Anti-GBM antibodies generally are of immunoglobulin G subclass 1 (IgG1) and can in most cases readily be detected in the circulation using enzyme-linked immunosorbent assays (ELISAs). We report 4 cases in which anti-GBM ELISA yielded negative or borderline results despite life-threatening disease. All 4 patients had positive results by IgG4 anti-GBM ELISA and all had undetectable antineutrophil cytoplasmic antibody. All cases were confirmed with kidney biopsy. Two of the patients showed higher signal in anti-GBM ELISA when using a nondenaturing coating buffer. All 4 were young women with severe alveolar hemorrhage and favorable renal outcome, suggesting that patients with predominance of IgG4 autoantibodies may constitute a distinct subgroup of anti-GBM disease. We conclude that patients with idiopathic alveolar hemorrhage can have anti-GBM disease detected by only IgG subclass-specific tests or kidney biopsy.
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- author
- Ohlsson, Sophie LU ; Herlitz, Hans ; Lundberg, Sigrid ; Selga, Daina LU ; Mölne, Johan ; Wieslander, Jörgen LU and Segelmark, Mårten LU
- publishing date
- 2014-02
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Adolescent, Adult, Anti-Glomerular Basement Membrane Disease/blood, Autoantibodies/biosynthesis, False Negative Reactions, Female, Humans, Immunoassay/methods, Immunoglobulin G/biosynthesis, Young Adult
- in
- American Journal of Kidney Diseases
- volume
- 63
- issue
- 2
- pages
- 5 pages
- publisher
- Elsevier
- external identifiers
-
- scopus:84892949840
- pmid:24189476
- ISSN
- 1523-6838
- DOI
- 10.1053/j.ajkd.2013.08.032
- language
- English
- LU publication?
- no
- id
- dcecf45e-d5b3-451e-890c-764c9c7e29fc
- date added to LUP
- 2018-06-16 22:30:19
- date last changed
- 2024-04-15 08:23:57
@article{dcecf45e-d5b3-451e-890c-764c9c7e29fc, abstract = {{<p>Autoantibodies against a constituent of the glomerular basement membrane (GBM), the α3-chain of type IV collagen, can cause both rapidly progressive glomerulonephritis and alveolar hemorrhage, referred to as anti-GBM disease or Goodpasture disease. Anti-GBM antibodies generally are of immunoglobulin G subclass 1 (IgG1) and can in most cases readily be detected in the circulation using enzyme-linked immunosorbent assays (ELISAs). We report 4 cases in which anti-GBM ELISA yielded negative or borderline results despite life-threatening disease. All 4 patients had positive results by IgG4 anti-GBM ELISA and all had undetectable antineutrophil cytoplasmic antibody. All cases were confirmed with kidney biopsy. Two of the patients showed higher signal in anti-GBM ELISA when using a nondenaturing coating buffer. All 4 were young women with severe alveolar hemorrhage and favorable renal outcome, suggesting that patients with predominance of IgG4 autoantibodies may constitute a distinct subgroup of anti-GBM disease. We conclude that patients with idiopathic alveolar hemorrhage can have anti-GBM disease detected by only IgG subclass-specific tests or kidney biopsy. </p>}}, author = {{Ohlsson, Sophie and Herlitz, Hans and Lundberg, Sigrid and Selga, Daina and Mölne, Johan and Wieslander, Jörgen and Segelmark, Mårten}}, issn = {{1523-6838}}, keywords = {{Adolescent; Adult; Anti-Glomerular Basement Membrane Disease/blood; Autoantibodies/biosynthesis; False Negative Reactions; Female; Humans; Immunoassay/methods; Immunoglobulin G/biosynthesis; Young Adult}}, language = {{eng}}, number = {{2}}, pages = {{93--289}}, publisher = {{Elsevier}}, series = {{American Journal of Kidney Diseases}}, title = {{Circulating anti-glomerular basement membrane antibodies with predominance of subclass IgG4 and false-negative immunoassay test results in anti-glomerular basement membrane disease}}, url = {{http://dx.doi.org/10.1053/j.ajkd.2013.08.032}}, doi = {{10.1053/j.ajkd.2013.08.032}}, volume = {{63}}, year = {{2014}}, }