Immunological and Clinical Studies of Renal Glomerular Basement Membrane (GBM)

Part II. The role of anti-GBM antibody in the Pathogenesis of Human Glomerulonephritis

Abstract

Circulating anti-GBM antibodies were examined in various forms of human glomerulonephritis(GN) by passive hemagglutination test using prepared human soluble GBM antigen. Also, these assay system were fundamentaly checked up. Their clinical diagnosis were acute GN in 13, rapidly progressive GN in 1, chronic GN in 36, membranous nephropathy in 15, IgA-IgG nephropathy in 9, membranoproliferative GN (MPGN) in 4, lipoid nephrosis in 6, purpura nephritis in 2 and acute renal failure in 2. The relationship between circulating anti-GBM antibodies and the clincal diagnosis, the renal histological findings, the renal immunofluorescent findings, the streptcoccal infection and the clinical findings were investigated. The pathogenetic role as well as the methods of detection and the significance of circulating anti-GBM antibodies in human GN were discussed. 1. This method used here is excellent than the methods of immunofluorescence and Ouhterloney on the aspect of specificity and sensitivity. 2. Circulating anti-GBM antibodies were found in high titer in patients with 5 of acute GN, 1 of rapidly progressive GN, 4 of chron GN and 1 of MPGN. 3. High titer of circulating anti-GBM antibodies were found in proliferative GN, but 1 of MPGN and sclerosing GN had also high titer. The grade of proliferation were more severe in the patients with linear deposits of IgG on the GBM associated with one of complement. 4. Positive circulating anti-GBM antibodies were found in patients with linear deposits of IgG on the GBM, but 3 patients with mixed patte.zn had also high titer. 5. The group with elevated ASLO titers contained significantly more number of patients with positive circulating anti-GBM antibodies than one with normal ASLO titers. 6. The clinical course of poststreptcoccal GN with positive circulating auti-GBM antibodies cont-inued for more bug period compared with one with negative circualting anti-GBM antibodies. 7. The patients with positiva ciroilating anti-GBM antibodies were divided into four group :·typical onset of acute or rapidly progressive poststreptcoccal GN.μtypical anti-GBM antibody induced GN from unknown onset without streptcoccal infection.·evolution of immune complex GN into anti-GBM antibody GN.·immune complex GN only with positive circulating anti-GBM antibodies.