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Recurrent, atypical anti-glomerular basement membrane disease

1 Department of Nephrology and Transplantation; Curtin University, Bentley; University of Western Australia, Crawley, Western Australia
2 University of Western Australia, Crawley; Department of Anatomical Pathology, Fiona Stanley Hospital, Murdoch, Western Australia
3 University of Western Australia, Crawley; Department of Clinical Immunology, Fiona Stanley Hospital, Murdoch, Western Australia
4 Nephrology Service, Bendigo, Monash University Rural School of Health, Bendigo, Victoria, Western Australia

Correspondence Address:
Jagadish S Jamboti,
Department of Nephrology and Transplantation, Fiona Stanley Hospital, 11, Robin Warren Drive, Murdoch 6150
Western Australia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijn.IJN_414_19

Anti-glomerular basement membrane disease (GBM) (Goodpasture's disease) typically presents with acute manifestations of rapidly progressive glomerulonephritis often accompanied by lung haemorrhage. Anti-GBM disease is usually monophasic. However, atypical presentations with indolent renal involvement are being increasingly recognized. Herein we report a patient who presented with lung haemorrhage, minimal renal involvement, and negative result for serum anti-GBM antibody, while immunofluorescence examination of the renal biopsy provided the diagnosis leading to the institution right treatment with excellent response. Interestingly, he had presented 10 years earlier with lung hemorrhage, more significant renal involvement clinically and histologically, with positive serum anti-GBM antibody. The present case is intended to increase our awareness regarding the variable presentations of anti-GBM disease, such as with negative serology and recurrence of anti-GBM disease. The presentation of anti-GBM nephritis with non-proliferative, non-crescentic glomerulonephritis is also highlighted. The possible explanations for negative serum anti-GBM antibody are explored with a brief review of literature.

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Indian Journal of Nephrology
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