A Case of Membranoproliferative Glomerulonephritis with False-Positive Reaction for Anti-GBM Antibody.
- Author:
Kyoung Suk PARK
1
;
Seun Duk HWANG
;
Byung Soo JEON
;
Jin Yi CHOI
;
Ji Sun SONG
;
Soo Young YOON
;
Sang Choel LEE
Author Information
1. Department of Internal Medicine, College of Medicine, Kwandong University, Goyang, Korea. drjoy@kd.ac.kr
- Publication Type:Case Report
- Keywords:
Antiglomerular basement membrane antibody;
false positive reactions;
Membranoproliferative glomerulonephritis
- MeSH:
Acute Kidney Injury;
Anti-Glomerular Basement Membrane Disease;
Antibodies;
Autoantibodies;
Basement Membrane;
Biopsy;
Early Diagnosis;
Edema;
False Positive Reactions;
Fluorescent Antibody Technique;
Follow-Up Studies;
Glomerular Basement Membrane;
Glomerulonephritis;
Glomerulonephritis, Membranoproliferative;
Hepatitis B;
Humans;
Hypertension;
Immunoenzyme Techniques;
Immunoglobulins;
Kidney;
Male;
Mass Screening;
Microscopy;
Middle Aged;
Nephritis;
Nephrotic Syndrome;
Plasmapheresis;
Steroids
- From:Korean Journal of Nephrology
2009;28(5):480-484
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Anti-glomerular basement membrane (Anti-GBM) nephritis is an autoimmune disorder characterized by rapidly progressive crescentic glomerulonephritis (RPGN). The treatment of anti-GBM nephritis with plasmapheresis, steroids and immunosuppressant has improved outcomes. An early diagnosis is essential for the survival of patients and a recovery of renal function. The diagnosis of anti-GBM disease has been traditionally based on the demonstration of linear deposits of immunoglobulins along the glomerular basement membrane by immunofluorescence (IF) microscopy. However, a kidney biopsy cannot always be easily performed in such ill patients. Recent development of specific enzyme immunoassays for anti-GBM antibody in the serum has made possible a provisional diagnosis without a kidney biopsy. A 46-year-old male patient with hypertension and hepatitis B presented with generalized edema and general weakness. Laboratory findings were compatible with acute renal failure and nephrotic syndrome with positive serum anti-GBM antibodies. After plasmapheresis with steroid pulse therapy, renal biopsy was performed and diagnosed as membranoproliferative glomerulonephritis (MPGN) with granular deposit of Ig G and C3. Follow-up antibody titers were negative. This case demonstrates the possibility of false-positive anti-GBM antibody in the serum. Therefore, enzyme immunoassay for anti-GBM antibody should be used only as a screening or follow-up test in patients that have been confirmed positive by IF microscopy.
