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Circulating anti-glomerular basement membrane antibodies with predominance of subclass IgG4 and false-negative immunoassay test results in anti-glomerular basement membrane disease

Ohlsson, Sophie LU ; Herlitz, Hans; Lundberg, Sigrid; Selga, Daina LU ; Mölne, Johan; Wieslander, Jörgen LU and Segelmark, Mårten LU (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
publishing date
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
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
2018-10-28 04:53:48
@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},
  keyword      = {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},
  volume       = {63},
  year         = {2014},
}