Exam Cram

• Goodpasture's: anti GBM (glomerular basement membrane) IgG against lung & kidneys

• Presentation: lung (haemoptysis, sob) + kidney involvement (haemoproteinuria, AKI)

• Normal CRP/ ESR

• Management: steroids +/- cyclophosphamide

Outline

Background

Assessment

History

• Short of breath, cough, fevers, chest pain

• Triggered by recent upper respiratory tract infection

Examination

• Widespread crackles

Investigations

• Biopsy: kidneys or lung: specificity 100%

• Anti-GBM antibodies: sensitivity 90%

• Urinanalysis: haemoproteinuria- high sensitivity (if normal Goodpasture's unlikely)

• Anaemia, creatinine rise

• CXR: patchy parenchymal opacifications

Diagnosis & Classification

Diagnostic criteria: biopsy- kidney or lung 

Differentials: GPA has a raised ESR/ CRP and sinusitis

Management

Acute

1. Renal Consult

2. Stabilise- intubation or haemodialysis as required

3. Plasma exchange

4. Steroids + cyclophosphamide or rituxumab

5. Renal biopsy when available (for diagnosis)

Med Reg Notes

• Kidney biopsy preferred to a lung biopsy due to its higher yield

Prognostic factors

• % Healthy glomerulus on renal biopsy: > 50% good

• BP control

References and Resources

1. https://www.niddk.nih.gov/health-information/kidney-disease/glomerular-disease/anti-gbm-goodpastures-disease

2. Rout P, DeVrieze BW. Goodpasture Syndrome. [Updated 2024 Jun 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459291/

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Written in 2025.