Clinical significance of anti-glomerular basement membrane antibodies in a cohort of Chinese patients with lupus nephritis.

OBJECTIVES

To evaluate the clinical and laboratory features of patients with lupus nephritis (LN) in the presence and absence of anti-glomerular basement membrane antibodies (anti-GBM) and to establish whether the characteristics of the disease correlate with anti-GBM.

METHODS

We performed a retrospective study of 157 hospitalised patients with systemic lupus erythematosus (SLE), 91 of whom had LN. The test for anti-GBM used an enzyme-linked immunosorbent assay (ELISA). Clinical and laboratory data were collected and assessed in LN patients with and without anti-GBM.

RESULTS

Anti-GBM was detected in 14 (8.9%) of 157 patients with SLE. All of the 14 patients developed LN; of these, 10 reached the criteria for crescentic glomerulonephritis (CGN) and five were diagnosed as Goodpasture's disease. Serum anti-GBM levels were correlated with the presence of both anti-double-stranded DNA antibodies (anti-dsDNA) and anti-nucleosome antibodies (anti-NuA). Significant differences in extrarenal clinical manifestations were found between anti-GBM-positive and -negative LN patients, with regard to pleuritis, pulmonary haemorrhage, sinusitis, and anaemia in particular.

CONCLUSIONS

LN with anti-GBM is not rare in Chinese patients. Anti-GBM, together with the additional nephritogenic potential of anti-dsDNA and anti-NuA, may play an essential role in the pathogenesis of the anti-GBM disease in LN. Therefore, in addition to routine anti-GBM assay, anti-dsDNA and anti-NuA measurements should be performed early to ensure a prompt diagnosis and immediate treatment in patients with anti-GBM-mediated disease.