Antiglomerular Basement Membrane Antibody

General

Synonym/Acronym:
Goodpasture antibody, anti-GBM.

Rationale
To assist in differentiating Goodpasture syndrome (an autoimmune disease) from renal dysfunction.

Patient Preparation
There are no food, fluid, activity, or medication restrictions unless by medical direction.

Normal Findings
(Method: Immunofluorescent antibody IgG) Negative.

Critical Findings and Potential Interventions
N/A

Overview

(Study type: Blood collected in a gold-, red-, or red/gray-top tube; related body system: Immune, Respiratory, Urinary systems. Lung or kidney tissue may also be submitted for testing. Refer to related biopsy studies for specimen-collection instructions.)

Glomerulonephritis, or inflammation of the kidney, is initiated by an immune response, usually to an infection. It can be classified as either antibody-mediated or cell-mediated glomerulonephritis. Goodpasture syndrome is a rare hypersensitivity condition characterized by the presence of circulating antiglomerular basement membrane (anti-GBM) antibodies in the blood and the deposition of immunoglobulin and complement in renal basement membrane tissue. Severe and progressive glomerulonephritis can lead to the development of pulmonary hemorrhage and idiopathic pulmonary hemosiderosis. The presence of anti-GBM antibodies can also be demonstrated in renal biopsy tissue cells of affected patients. Autoantibodies may also be directed to act against lung tissue in Goodpasture syndrome.

Indications

  • Differentiate glomerulonephritis caused by anti-GBM from glomerulonephritis from other causes.
  • Monitor therapy for glomerulonephritis caused by anti-GBM.

Interfering Factors

N/A

Potential Medical Diagnosis: Clinical Significance of Results

Increased in

  • Glomerulonephritis (of autoimmune origin as evidenced by the presence of anti-GBM antibodies)
  • Goodpasture syndrome (related to nephritis of autoimmune origin)
  • Idiopathic pulmonary hemosiderosis

Decreased in

N/A

Nursing Implications, Nursing Process, Clinical Judgement

Before the Study: Planning and Implementation

Teaching the Patient What to Expect

  • Discuss how this test can assist in diagnosing a disease that can affect the kidneys or lungs.
  • Explain that a blood sample is needed for the test.

After the Study: Implementation & Evaluation Potential Nursing Actions

Treatment Considerations

  • Discuss the symptoms that can be expected for those who have a positive diagnosis of Goodpasture disease.
  • Note that symptoms to be aware of that affect the lung are pallor, crackles, rhonchi, cough, hemoptysis, dyspnea, heart murmur, edema, and enlarged liver.
  • Note that symptoms to be aware of the affect the kidneys are blood or protein in the urine, high blood pressure, and abnormal kidney function.
  • Consider facilitating genetic counseling for those who have HLA antigen results identified as a likely causal factor.
  • Discuss the possibility of using plasmapheresis with the administration of cyclophosphamide and corticosteroids to remove circulating antibodies as per HCP.
  • Provide counseling and emotional support as needed; Goodpasture syndrome can shorten life expectancy.
  • Discuss how individuals who are exposed to environmental factors such as cigarette smoke (first or second hand), use hair dyes, or are exposed to hydrocarbon fumes are at increased risk for developing Goodpasture syndrome.

Nutritional Considerations

  • Recognizes dietary sodium may need to be decreased due to altered kidney function.

Clinical Judgement

  • Consider which agency or group can provide the best support on a long-term basis for a diagnosis that can be life shortening and may be terminal.

Followup Evaluation and Desired Outcomes

  • Understands that effective treatment requires timely reporting of symptoms allowing for real-time changes to the therapeutic plan.
  • Acknowledges plasmaphoresis may be necessary to filter the blood.
  • Understands failure to treat can result in death.
  • Acknowledges information provided to link with supportive groups such as American Autoimmune Related Diseases Association (AARDA), https://www.aarda.org/and National Kidney Foundation https://www.kidney.org/

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