Abstract
The patient was a 48-year-old woman. She had a cold and was treated with antibiotics by her home doctor in late December 1999. Since edema of the eyelids developed, she was referred to our hospital on January 19, 2000. On admission, she demonstrated renal failure (BUN 64.2mg/dl, Cr 8.2mg/dl) and microcytic hypochromic anemia (Hb 5.6g/dl, MCV 57.1fl, MCH 17.8pg). Urinalysis showed 1+ protein and 50 to 100 red blood cells per high power field. She did not show hemosputum or hemoptysis, and there was no abnormal shadow on chest X-ray. Acute renal failure due to antibiotics was suspected and hemodialysis was instituted on the second day after admission. On the 12th day after admission, abnormal shadow on chest X-ray was observed and bronchoscopy revealed pulmonary hemorrhage. Anti-glomerular basement membrane antibody (anti-GBM antibody) was high at 300EU/ml, and Goodpasture's syndrome was diagnosed. She was treated with methylprednisolone (500mg/day, for 3 days) and plasma exchange (for 6 days). Although the serum level of anti-GBM antibody decreased and pulmonary hemorrhage was cured, renal function did not improve and chronic hemodialysis therapy was necessary.
Since the prognosis of Goodpasture's syndrome is still poor (mortality about 50%), early diagnosis and the prompt treatment with steroid, immunosuppressive drug, and plasmapheresis are essential. When the patient with acute renal failure shows heavy hematuria and microcytic hypochromic anemia, careful consideration of the possibility of Goodpasture's syndrome is recommended.
