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{{Goodpastures syndrome }}
{{Goodpastures syndrome }}
{{CMG}}{{APM}}{{AE}}{{KW}}
{{CMG}}{{APM}}; {{AE}}{{KW}}{{Akshun}}


==Overview==
==Overview==
Laboratory findings consistent with the diagnosis of Goodpasture syndrome include, anti-glomerular basement membrane antibodies elevated blood urea nitrogen, low-grade proteinuria, leukocytosis, gross or microscopic hematuria, and red cell casts.
Laboratory findings consistent with the diagnosis of Goodpasture syndrome include presence of [[autoantibodies]] such as [[Anti-glomerular basement membrane antibody|anti-glomerular basement membrane antibodies]]. Other findings associated with [[pulmonary]] and [[renal]] injury include elevated [[blood urea nitrogen]], low-grade [[proteinuria]], gross or [[microscopic hematuria]], and red cell casts.


==Laboratory Findings==
==Laboratory Findings==
Laboratory findings consistent with the diagnosis of Goodpasture syndrome include, anti-glomerular basement membrane antibodies, elevated blood urea nitrogen, low-grade proteinuria, leukocytosis, gross or microscopic hematuria, and red cell casts. If laboratory findings do not show anti-glomerular basement membrane antibodies, a test for anti-neutrophil cytoplasmic antibodies should be made to determine possible cause of ANCA associated vasculitis. Routine laboratory test that may be ordered to help in identifying the cause are:
Laboratory findings consistent with the diagnosis of Goodpasture syndrome include presence of [[autoantibodies]] such as [[Anti-glomerular basement membrane antibody|anti-glomerular basement membrane antibodies.]]<ref name="pmid16234289">{{cite journal |vauthors=Sinico RA, Radice A, Corace C, Sabadini E, Bollini B |title=Anti-glomerular basement membrane antibodies in the diagnosis of Goodpasture syndrome: a comparison of different assays |journal=Nephrol. Dial. Transplant. |volume=21 |issue=2 |pages=397–401 |date=February 2006 |pmid=16234289 |doi=10.1093/ndt/gfi230 |url=}}</ref><ref name="pmid19741587">{{cite journal |vauthors=Zhao J, Cui Z, Yang R, Jia XY, Zhang Y, Zhao MH |title=Anti-glomerular basement membrane autoantibodies against different target antigens are associated with disease severity |journal=Kidney Int. |volume=76 |issue=10 |pages=1108–15 |date=November 2009 |pmid=19741587 |doi=10.1038/ki.2009.348 |url=}}</ref><ref name="pmid19151145">{{cite journal |vauthors=Yang R, Hellmark T, Zhao J, Cui Z, Segelmark M, Zhao MH, Wang HY |title=Levels of epitope-specific autoantibodies correlate with renal damage in anti-GBM disease |journal=Nephrol. Dial. Transplant. |volume=24 |issue=6 |pages=1838–44 |date=June 2009 |pmid=19151145 |doi=10.1093/ndt/gfn761 |url=}}</ref>  
 
* Other findings associated with [[pulmonary]] and [[renal injury]] include elevated [[blood urea nitrogen]], low-grade [[proteinuria]], gross or [[microscopic hematuria]], and red cell casts.  
===Blood Work-up===<ref name="pmid25462583">{{cite journal| author=Greco A, Rizzo MI, De Virgilio A, Gallo A, Fusconi M, Pagliuca G et al.| title=Goodpasture's syndrome: a clinical update. | journal=Autoimmun Rev | year= 2015 | volume= 14 | issue= 3 | pages= 246-53 | pmid=25462583 | doi=10.1016/j.autrev.2014.11.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25462583  }} </ref>
* If laboratory test cannot detect the presence of [[Anti-glomerular basement membrane antibody|anti-glomerular basement membrane antibodies]], other tests such as [[Anti-neutrophil cytoplasmic antibody|anti-neutrophil cytoplasmic antibodies]] ([[ANCA]]) should be done to determine and rule out the presence of [[ANCA]] associated [[vasculitis]].<ref name="pmid1317224">{{cite journal |vauthors=Weber MF, Andrassy K, Pullig O, Koderisch J, Netzer K |title=Antineutrophil-cytoplasmic antibodies and antiglomerular basement membrane antibodies in Goodpasture's syndrome and in Wegener's granulomatosis |journal=J. Am. Soc. Nephrol. |volume=2 |issue=7 |pages=1227–34 |date=January 1992 |pmid=1317224 |doi= |url=}}</ref>
* Complete blood count (CBC)
* Routine laboratory test that may be ordered to help in identifying the cause are:
* Uremia
** [[Complete blood count]] ([[leukocytosis]] and [[anemia]])
* Serum creatinine
** [[Renal function tests|Renal function test]] ([[Blood urea nitrogen|BUN]], [[Serum creatinine|S. creatinine]])
* Blood urea nitrogen (BUN)
** [[Urinalysis]] for [[proteinuria]], [[hematuria]], and red cell casts
* Anti-glomerular basement membrane test
** [[ESR]] and [[CRP]]
* Anti-neutrophil cytoplasmic antibody test
*Pulmonary function testing (PFT) may be done to determine the extent of disease as patients with Goodpasture syndrome tend to have [[interstitial fibrosis]] and a [[Restrictive lung disease|restrictive pattern]] on PFTs.
 
*The diffusing capacity for carbon monoxide ([[DLCO]]) is also elevated due to destruction of [[alveolar]] [[basement membrane]] and subsequent [[fibrosis]].
===Urinalysis===
* Proteinuria
* Hematuria
* Red cell casts
 
===Renal Biopsy===
Renal biopsy is the gold standard in establishing Goodpasture syndrome.<ref name="pmid22218111">{{cite journal| author=Alenzi FQ, Salem ML, Alenazi FA, Wyse RK| title=Cellular and molecular aspects of Goodpasture syndrome. | journal=Iran J Kidney Dis | year= 2012 | volume= 6 | issue= 1 | pages= 1-8 | pmid=22218111 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22218111  }} </ref> As it can help establish the detection of circulating anti-glomerular basement membrane antibodies. It is of note that a renal biopsy is best over a pulmonary biopsy because of abundance of autofluorecene. <ref name="pmid12815141">{{cite journal| author=Hudson BG, Tryggvason K, Sundaramoorthy M, Neilson EG| title=Alport's syndrome, Goodpasture's syndrome, and type IV collagen. | journal=N Engl J Med | year= 2003 | volume= 348 | issue= 25 | pages= 2543-56 | pmid=12815141 | doi=10.1056/NEJMra022296 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12815141  }}</ref> Renal biopsy reveals early focal proliferative changes that present with necrosis, crescent formation, and inflammation of the interstitial under light microscopy. Under direct immunofluorescence, linear immunoglobulin G (IgG) deposits are seen encompassing the glomerular basement membrane and at times the distal tubular portion.<ref name="pmid25462583">{{cite journal| author=Greco A, Rizzo MI, De Virgilio A, Gallo A, Fusconi M, Pagliuca G et al.| title=Goodpasture's syndrome: a clinical update. | journal=Autoimmun Rev | year= 2015 | volume= 14 | issue= 3 | pages= 246-53 | pmid=25462583 | doi=10.1016/j.autrev.2014.11.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25462583  }}</ref>  
 
 
 
 
 


==References==
==References==

Latest revision as of 14:38, 19 July 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Ali Poyan Mehr, M.D. [2]; Associate Editor(s)-in-Chief: Krzysztof Wierzbicki M.D. [3] Akshun Kalia M.B.B.S.[4]

Overview

Laboratory findings consistent with the diagnosis of Goodpasture syndrome include presence of autoantibodies such as anti-glomerular basement membrane antibodies. Other findings associated with pulmonary and renal injury include elevated blood urea nitrogen, low-grade proteinuria, gross or microscopic hematuria, and red cell casts.

Laboratory Findings

Laboratory findings consistent with the diagnosis of Goodpasture syndrome include presence of autoantibodies such as anti-glomerular basement membrane antibodies.[1][2][3]

References

  1. Sinico RA, Radice A, Corace C, Sabadini E, Bollini B (February 2006). "Anti-glomerular basement membrane antibodies in the diagnosis of Goodpasture syndrome: a comparison of different assays". Nephrol. Dial. Transplant. 21 (2): 397–401. doi:10.1093/ndt/gfi230. PMID 16234289.
  2. Zhao J, Cui Z, Yang R, Jia XY, Zhang Y, Zhao MH (November 2009). "Anti-glomerular basement membrane autoantibodies against different target antigens are associated with disease severity". Kidney Int. 76 (10): 1108–15. doi:10.1038/ki.2009.348. PMID 19741587.
  3. Yang R, Hellmark T, Zhao J, Cui Z, Segelmark M, Zhao MH, Wang HY (June 2009). "Levels of epitope-specific autoantibodies correlate with renal damage in anti-GBM disease". Nephrol. Dial. Transplant. 24 (6): 1838–44. doi:10.1093/ndt/gfn761. PMID 19151145.
  4. Weber MF, Andrassy K, Pullig O, Koderisch J, Netzer K (January 1992). "Antineutrophil-cytoplasmic antibodies and antiglomerular basement membrane antibodies in Goodpasture's syndrome and in Wegener's granulomatosis". J. Am. Soc. Nephrol. 2 (7): 1227–34. PMID 1317224.

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