A 27-year-old man is investigated tor haemoptysis He is a non-smoker and has no respiratory history
of note. Whilst awaiting a bronchoscopy he becomes lethargic and anorexic Blood tests show the
following'
Na+ 141 mmol/l
K+ 5,3 mmol/l
Urea 16.7 mmol/l
Creatinine 271 umol/1
A renal biopsy is performed and shows linear IgG deposits along the basement membrane.
What type of antibodies are most likely to cause this type of presentation?
0 cANCA
© IgA
© pANCA
Anti-nuclear antibodies (ANA)
Anti-glomerular basement membrane (anti-GBM) antibodies
,A 27-year-old man is investigated for haemoptysis. He is a non-smoKer and has no respiratory history
of note. Whilst awaiting a bronchoscopy he becomes lethargic and anorexic. Blood tests show the
following:
Na+ 141 mmol/1
K+ 5.3 mmol/1
urea 16.7 mmol/1
Creatinine 271 µmol/1
A renal biopsy is performed and shows linear lgG deposits along the basement membrane.
What type of antibodies are most liKely to cause this type of presentation?
® cANCA
(E) lgA
el pANCA
e> Anti-nuclear antibodies (ANA)
Anti-glomerular basement membrane (anti-GBM) antibodies
, Goodpasture's syndrome
* IgG deposits on renal biopsy
* anti-GBM antibodies
The combination of haemoptsis, renal failure and linear IgG deposits points to a diagnosis of
Goodpasture's syndrome.
The ANCA-related nephropathies are associated with crescentic glomerulonephritis.
Goodpasture’s syndrome
Goodpasture's syndrome is rare condition associated with both pulmonary haemorrhage and rapidly
progressive glomerulonephritis. It is caused by anti-glomerular basement membrane (anti-GBM)
antibodies against type IV collagen. Goodpasture's syndrome is more common in men (sex ratio 2:1)
and has a bimodal age distribution (peaks in 20-30 and 60-70 age bracket). It is associated with HLA
DR2.
Features
■ pulmonary haemorrhage
* followed by rapidly progressive glomerulonephritis
Factors which increase likelihood of pulmonary haemorrhage
* smoking
* lower respiratory tract infection
* pulmonary oedema
* inhalation of hydrocarbons
■ young males
Investigations
• renal biopsy: linear IgG deposits along basement membrane
* raised transfer factor secondary to pulmonary haemorrhages
Management
* plasma exchange
* steroids
* cyclophosphamide
Save my notes
,A 24-year-old woman is diagnosed as having nephrotic syndrome after being investigated for
proteinuria. A diagnosis of minimal change glomerulonephritis is made. What is the most appropriate
initial treatment to reduce proteinuria?
© Protein restriction in diet
© No treatment shown to effective
© Angiotensin-converting -enzyme inhibitor
© Diuretic
© Prednisolone
Submit answer ©3J9ÿ.9
of note. Whilst awaiting a bronchoscopy he becomes lethargic and anorexic Blood tests show the
following'
Na+ 141 mmol/l
K+ 5,3 mmol/l
Urea 16.7 mmol/l
Creatinine 271 umol/1
A renal biopsy is performed and shows linear IgG deposits along the basement membrane.
What type of antibodies are most likely to cause this type of presentation?
0 cANCA
© IgA
© pANCA
Anti-nuclear antibodies (ANA)
Anti-glomerular basement membrane (anti-GBM) antibodies
,A 27-year-old man is investigated for haemoptysis. He is a non-smoKer and has no respiratory history
of note. Whilst awaiting a bronchoscopy he becomes lethargic and anorexic. Blood tests show the
following:
Na+ 141 mmol/1
K+ 5.3 mmol/1
urea 16.7 mmol/1
Creatinine 271 µmol/1
A renal biopsy is performed and shows linear lgG deposits along the basement membrane.
What type of antibodies are most liKely to cause this type of presentation?
® cANCA
(E) lgA
el pANCA
e> Anti-nuclear antibodies (ANA)
Anti-glomerular basement membrane (anti-GBM) antibodies
, Goodpasture's syndrome
* IgG deposits on renal biopsy
* anti-GBM antibodies
The combination of haemoptsis, renal failure and linear IgG deposits points to a diagnosis of
Goodpasture's syndrome.
The ANCA-related nephropathies are associated with crescentic glomerulonephritis.
Goodpasture’s syndrome
Goodpasture's syndrome is rare condition associated with both pulmonary haemorrhage and rapidly
progressive glomerulonephritis. It is caused by anti-glomerular basement membrane (anti-GBM)
antibodies against type IV collagen. Goodpasture's syndrome is more common in men (sex ratio 2:1)
and has a bimodal age distribution (peaks in 20-30 and 60-70 age bracket). It is associated with HLA
DR2.
Features
■ pulmonary haemorrhage
* followed by rapidly progressive glomerulonephritis
Factors which increase likelihood of pulmonary haemorrhage
* smoking
* lower respiratory tract infection
* pulmonary oedema
* inhalation of hydrocarbons
■ young males
Investigations
• renal biopsy: linear IgG deposits along basement membrane
* raised transfer factor secondary to pulmonary haemorrhages
Management
* plasma exchange
* steroids
* cyclophosphamide
Save my notes
,A 24-year-old woman is diagnosed as having nephrotic syndrome after being investigated for
proteinuria. A diagnosis of minimal change glomerulonephritis is made. What is the most appropriate
initial treatment to reduce proteinuria?
© Protein restriction in diet
© No treatment shown to effective
© Angiotensin-converting -enzyme inhibitor
© Diuretic
© Prednisolone
Submit answer ©3J9ÿ.9
