The spectrum of renal diseases associated with anti-basement membrane antibodies.

Nephritis associated with anti-basement membrane antibodies includes a spectrum of glomerular and/or tubulointerstitial involvement. The glomerluar disease may present as Goodpasture's syndrome, rapidly progressive glomerulonephritis, a mild focal, segmental, proliferative glomerulonephritis, or chronic glomerulonephritis. The tubulointerstitial nephritis is associated with antibodies directed against the basement membrane of the tubules and may occur as a result of drug hypersensitivity. Routine light microscopy or electron microscopy may not be diagnostic of these syndromes. Immunofluorescent examination of renal tissue demonstrates a smooth, linear pattern of immunoglobulin or complement deposition along the glomerular or tubular basement membrane. Anti-basement membrane antibodies may also be detected in the circulation. Treatment of these syndromes is directed at eradication of the stimulus for antibody production, blockage of antibody production by immunosuppressive drugs, and removal of the existing antibody from the circulation by plasmapheresis or plasma exchange transfusion.