Failure of plasma exchange and immunosuppression to improve renal function in Goodpasture's syndrome.

A young woman with anti-glomerular basement membrane (GBM) antibody mediated rapidly progressive glomerulonephritis and pulmonary hemorrhage was treated with immunosuppression and intensive plasma exchange. She did not have end stage renal failure when therapy was initiated. Despite a dramatic reduction in circulating anti-GBM antibody, renal function progressively decreased. The role of plasma exchange in the therapy of anti-GBM antibody mediated disease remains unclear.