antiglomerular

Antiglomerular refers to antibodies directed against antigens within the glomerulus of the kidney. The most well-characterized example is antibodies against the glomerular basement membrane (GBM), which can cause anti-GBM disease. When anti-GBM antibodies are present with pulmonary involvement, the condition is commonly called Goodpasture syndrome.

Pathophysiology and pathology involve binding of circulating antibodies to GBM, triggering complement activation and inflammation that can rapidly damage glomeruli. Kidney biopsy typically shows crescentic glomerulonephritis, and immunofluorescence reveals a linear pattern of IgG (and often C3) along the GBM.

Clinically, anti-GBM–related disease often presents as rapid-onset nephritic syndrome and rapidly progressive kidney failure. If Goodpasture syndrome is present, patients may also have hemoptysis due to pulmonary hemorrhage. Serological testing detects anti-GBM antibodies, commonly by ELISA or related immunoassays, and helps distinguish it from other forms of vasculitis.

Treatment aims to remove circulating antibodies and suppress ongoing immune activity. This typically includes plasma exchange to deplete antibodies, high-dose corticosteroids, and an alkylating agent such as cyclophosphamide or a B-cell–targeted therapy like rituximab. Supportive care includes blood pressure management and renal replacement therapy if needed.

Prognosis improves with rapid diagnosis and treatment; however, renal recovery depends on the degree of kidney involvement at presentation. The term antiglomerular may also be used in a broader sense to describe antibodies directed against other glomerular components, though anti-GBM disease is the primary and most clinically significant example.