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Circulating anti-glomerular basement membrane antibodies with predominance of subclass IgG4 and false-negative immunoassay test results in anti-glomerular basement membrane disease.
Am J Kidney Dis. 2014 Feb; 63(2):289-93.AJ

Abstract

Autoantibodies against a constituent of the glomerular basement membrane (GBM), the α3-chain of type IV collagen, can cause both rapidly progressive glomerulonephritis and alveolar hemorrhage, referred to as anti-GBM disease or Goodpasture disease. Anti-GBM antibodies generally are of immunoglobulin G subclass 1 (IgG1) and can in most cases readily be detected in the circulation using enzyme-linked immunosorbent assays (ELISAs). We report 4 cases in which anti-GBM ELISA yielded negative or borderline results despite life-threatening disease. All 4 patients had positive results by IgG4 anti-GBM ELISA and all had undetectable antineutrophil cytoplasmic antibody. All cases were confirmed with kidney biopsy. Two of the patients showed higher signal in anti-GBM ELISA when using a nondenaturing coating buffer. All 4 were young women with severe alveolar hemorrhage and favorable renal outcome, suggesting that patients with predominance of IgG4 autoantibodies may constitute a distinct subgroup of anti-GBM disease. We conclude that patients with idiopathic alveolar hemorrhage can have anti-GBM disease detected by only IgG subclass-specific tests or kidney biopsy.

Authors+Show Affiliations

Department of Nephrology and Transplantation, Skane University Hospital, Göteborg, Sweden.Department of Nephrology, Sahlgrenska University Hospital, Göteborg, Sweden.Department of Nephrology, Karolinska University Hospital, Stockholm, Sweden.Department of Nephrology and Transplantation, Skane University Hospital, Göteborg, Sweden.Department of Pathology, Sahlgrenska University Hospital, Göteborg, Sweden.Eurodiagnostica AB, Malmö, Sweden.Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Department of Nephrology, County Council of Östergötland, Linköping, Sweden. Electronic address: marten.segelmark@liu.se.

Pub Type(s)

Case Reports
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24189476

Citation

Ohlsson, Sophie, et al. "Circulating Anti-glomerular Basement Membrane Antibodies With Predominance of Subclass IgG4 and False-negative Immunoassay Test Results in Anti-glomerular Basement Membrane Disease." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 63, no. 2, 2014, pp. 289-93.
Ohlsson S, Herlitz H, Lundberg S, et al. Circulating anti-glomerular basement membrane antibodies with predominance of subclass IgG4 and false-negative immunoassay test results in anti-glomerular basement membrane disease. Am J Kidney Dis. 2014;63(2):289-93.
Ohlsson, S., Herlitz, H., Lundberg, S., Selga, D., Mölne, J., Wieslander, J., & Segelmark, M. (2014). Circulating anti-glomerular basement membrane antibodies with predominance of subclass IgG4 and false-negative immunoassay test results in anti-glomerular basement membrane disease. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 63(2), 289-93. https://doi.org/10.1053/j.ajkd.2013.08.032
Ohlsson S, et al. Circulating Anti-glomerular Basement Membrane Antibodies With Predominance of Subclass IgG4 and False-negative Immunoassay Test Results in Anti-glomerular Basement Membrane Disease. Am J Kidney Dis. 2014;63(2):289-93. PubMed PMID: 24189476.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Circulating anti-glomerular basement membrane antibodies with predominance of subclass IgG4 and false-negative immunoassay test results in anti-glomerular basement membrane disease. AU - Ohlsson,Sophie, AU - Herlitz,Hans, AU - Lundberg,Sigrid, AU - Selga,Daina, AU - Mölne,Johan, AU - Wieslander,Jörgen, AU - Segelmark,Mårten, Y1 - 2013/11/01/ PY - 2013/05/14/received PY - 2013/08/28/accepted PY - 2013/11/6/entrez PY - 2013/11/6/pubmed PY - 2014/3/19/medline KW - Anti–glomerular basement membrane (anti-GBM) KW - Goodpasture disease KW - immunoglobulin G4 (IgG4) SP - 289 EP - 93 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 63 IS - 2 N2 - Autoantibodies against a constituent of the glomerular basement membrane (GBM), the α3-chain of type IV collagen, can cause both rapidly progressive glomerulonephritis and alveolar hemorrhage, referred to as anti-GBM disease or Goodpasture disease. Anti-GBM antibodies generally are of immunoglobulin G subclass 1 (IgG1) and can in most cases readily be detected in the circulation using enzyme-linked immunosorbent assays (ELISAs). We report 4 cases in which anti-GBM ELISA yielded negative or borderline results despite life-threatening disease. All 4 patients had positive results by IgG4 anti-GBM ELISA and all had undetectable antineutrophil cytoplasmic antibody. All cases were confirmed with kidney biopsy. Two of the patients showed higher signal in anti-GBM ELISA when using a nondenaturing coating buffer. All 4 were young women with severe alveolar hemorrhage and favorable renal outcome, suggesting that patients with predominance of IgG4 autoantibodies may constitute a distinct subgroup of anti-GBM disease. We conclude that patients with idiopathic alveolar hemorrhage can have anti-GBM disease detected by only IgG subclass-specific tests or kidney biopsy. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/24189476/Circulating_anti_glomerular_basement_membrane_antibodies_with_predominance_of_subclass_IgG4_and_false_negative_immunoassay_test_results_in_anti_glomerular_basement_membrane_disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(13)01282-1 DB - PRIME DP - Unbound Medicine ER -