Pulmonary renal syndrome: treatment of acute renal failure secondary to double positive goodpasture syndrome

Rajkumar Prakashbhai Doshi, Viralkumar Patel, Keyur Patel, Maulik Patel


This is a case of a 34 year old female who presented with lower epigastric pain, flank pain and hematuria. Her symptoms started two days after being treated on Trimethoprim+Sulfamethoxazole for urinary tract infection. Worsening of her symptoms despite switching to Cephalexin prompted her to come to the emergency department. On admission, her creatinine was 5.3 mg/dL with potassium of 5.2 mEq/L and albuminuria of 100 mg/dL. Chest computed tomography (CT) without contrast revealed findings consistent with goodpasture disease. Biopsy of the kidney confirmed diffuse necrotizing and crescentic glomerulonephritis consistent with anti-glomerular basement membrane antibody disease. She was treated with plasmapheresis and steroids with complete resolution of symptoms at follow up.


Acute renal failure, Goodpasture syndrome, Plasmapheresis

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Lee RW, D’Cruz DP. Pulmonary renal vasculitis syndromes. Autoimmun Rev 9. 2010:657-60.

Salama AD, Levy JB, Lightstone L, Pusey CD. Goodpasture’s disease. Lancet. 2001;358:917-20.

Donaghy M, Rees AJ. Cigarette smoking and lung haemorrhage in glomerulonephritis caused by autoanti- bodies to glomerular basement membrane. Lancet. 1983;2:1390-3.

Levy JB, Lachmann RH, Pusey CD. Recurrent Goodpasture’s disease. Am J Kidney Dis. 1996;27:573-8.

Goodpasture E. The significance of certain pulmonary lesions in relation to the etiology of influenza. Am J Med Sci. 1919;158:863-70.

Calderon EJ, Wichmann I, Varela JM. Presence of glomerular basement membrane (GBM) antibodies in HIV-patients with Pneumocystis carinii pneumonia. Clin Exp Immunol. 1997;107:448-50.

Ooi JD, Holdsworth SR, Kitching AR. Advances in the patho- genesis of Goodpasture’s disease: From epitopes to autoantibodies to effector T cells. J Autoimmun. 2008;31:295-300.

Pusey CD. Anti-glomerular basement membrane disease. Kidney Int. 2003;64:1535–50.

Hellmark T, Burkhardt H, Wieslander J. Goodpasture disease. Characterization of a single conformational epitope as the target of pathogenic autoantibodies. J Biol Chem. 1999;274:25862–8.

Yang R, Hellmark T, Zhao J. Levels of epitope-specific autoantibodies correlate with renal damage in anti-GBM disease. Nephrol Dial Transplant. 2009;24:1838-44.

DE Zoysa J, Taylor D, Thein H, Yehia M. Incidence and features of dual anti-GBM-positive and ANCA-positive patients. Nephrology (Carlton). 2011;16:725-9.

Szczepiorkowski ZM, Bandarenko N, Kim HC. Guidelines on the use of therapeutic apheresis in clinical practice: evidence based approach from the Apheresis Applications Committee of the American Society for Apheresis. J Clin Apher. 2007;22:106-75.

Pusey CD, Levy JB. Plasmapheresis in immunologic renal disease. Blood Purif. 2012;33:190-8.

Lahmer T, Heemann U. Anti-glomerular basement membrane antibody disease: a rare autoimmune disorder affecting the kidney and the lung. Autoimmun Rev. 2012;12:169-73.

García-Cantón C, Toledo A, Palomar R. Goodpasture's syndrome treated with mycophenolate mofetil. Nephrol Dial Transplant. 2000;15:920–2.

Syeda UA, Singer NG, Magrey M. Anti-glomerular basement membrane antibody disease treated with rituximab: a case based review. Semin Arthritis Rheum. 2013;42:567-72.