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Next up, let's move up the list and let's talk about anti-glomerular basement membrane disease
which, I'll remind you, is one of the small vessel vasculitides and to keep highlighting this as we
go through. Okay, so anti-GBM antibody disease is actually one of the more rare vasculitides.
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It can affect men and women of any age, the pathophysiology of anti-GBM disease involves circulating
antibodies that are attacking either glomerular basement membranes or alveolar basement membranes.
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Used to be called Goodpasture's disease as I mentioned before and when you think Goodpasture's
you should be thinking about the kidneys and the lungs together. When you look at the kidneys,
you'll find a rapidly progressive glomerulonephritis. On urologic testing, you'll simply find
urinalysis with proteinuria, maybe some dysmorphic red cells and red cell cast would certainly
be a clue to this diagnosis. In the lungs, you're seeing hemorrhage. Perhaps you'll just see
pulmonary infiltrates that can be kind of vague, some dyspnea and cough when you're inquiring
about the patient's symptoms, and you may even potentially see overt hemoptysis under extreme
cases. Importantly, unlike most of the other vasculitides, anti-GBM disease for whatever reason does
not typically present with systemic symptoms like fevers and weight loss as we're seeing in our
patient. The diagnosis, like all the vasculitides, is usually going to require biopsy. There is
1or 2 exceptions that we hear about down the road and on biopsy shown here we have a normal
glomerulus and then we have a crescentic glomerulonephritis picture which would be typical on
biopsy of the kidneys and anti-GBM disease. What we can see here in this picture is in addition
to crescentic glomerulonephritis, there is also linear deposition of IgG along the glomerular
capillaries. Remember that anti-GBM disease is one of those immune complex small vessel vasculitides
which is distinguished from the pauci-immune ANCA-associated vasculitides by virtue of the
fact that you will find deposition of these immune complexes in tissues that you biopsy. And
lastly, if you perform some serum testing you could get anti-GBM antibodies which would further
support this diagnosis. Alright, yet again I think we've probably got to keep this one on our list
until we have some more data.