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

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 failu...

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Autores principales: Ossman, Rime, Buob, David, Hellmark, Thomas, Brocheriou, Isabelle, Peltier, Julie, Tamouza, Ryad, Dahan, Karine, Hertig, Alexandre, Rondeau, Eric, Galichon, Pierre
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4902534/
https://www.ncbi.nlm.nih.gov/pubmed/27175692
http://dx.doi.org/10.1097/MD.0000000000003654
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author Ossman, Rime
Buob, David
Hellmark, Thomas
Brocheriou, Isabelle
Peltier, Julie
Tamouza, Ryad
Dahan, Karine
Hertig, Alexandre
Rondeau, Eric
Galichon, Pierre
author_facet Ossman, Rime
Buob, David
Hellmark, Thomas
Brocheriou, Isabelle
Peltier, Julie
Tamouza, Ryad
Dahan, Karine
Hertig, Alexandre
Rondeau, Eric
Galichon, Pierre
author_sort Ossman, Rime
collection PubMed
description 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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spelling pubmed-49025342016-06-27 Factors Associated With Pathogenicity of Anti-Glomerular Basal Membrane Antibodies: A Case Report Ossman, Rime Buob, David Hellmark, Thomas Brocheriou, Isabelle Peltier, Julie Tamouza, Ryad Dahan, Karine Hertig, Alexandre Rondeau, Eric Galichon, Pierre Medicine (Baltimore) 5200 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. Wolters Kluwer Health 2016-05-13 /pmc/articles/PMC4902534/ /pubmed/27175692 http://dx.doi.org/10.1097/MD.0000000000003654 Text en Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed under the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
spellingShingle 5200
Ossman, Rime
Buob, David
Hellmark, Thomas
Brocheriou, Isabelle
Peltier, Julie
Tamouza, Ryad
Dahan, Karine
Hertig, Alexandre
Rondeau, Eric
Galichon, Pierre
Factors Associated With Pathogenicity of Anti-Glomerular Basal Membrane Antibodies: A Case Report
title Factors Associated With Pathogenicity of Anti-Glomerular Basal Membrane Antibodies: A Case Report
title_full Factors Associated With Pathogenicity of Anti-Glomerular Basal Membrane Antibodies: A Case Report
title_fullStr Factors Associated With Pathogenicity of Anti-Glomerular Basal Membrane Antibodies: A Case Report
title_full_unstemmed Factors Associated With Pathogenicity of Anti-Glomerular Basal Membrane Antibodies: A Case Report
title_short Factors Associated With Pathogenicity of Anti-Glomerular Basal Membrane Antibodies: A Case Report
title_sort factors associated with pathogenicity of anti-glomerular basal membrane antibodies: a case report
topic 5200
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4902534/
https://www.ncbi.nlm.nih.gov/pubmed/27175692
http://dx.doi.org/10.1097/MD.0000000000003654
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