PROGRESSION FROM GOODPASTURES DISEASE TO MEMBRANOUS GLOMERULONEPHRITIS

An unusual case of a patient with Goodpasture's disease presenting wit h hemoptysis, severe iron deficiency anemia and microscopic hematuria and proteinuria is described. Both circulating and tissue anti-glomeru lar basement membrane (GEM) antibodies were present, and renal functio n remained normal throughout. Immunosuppressive therapy was given for subclinical pulmonary hemorrhage with successful resolution of anemia and disappearance of the circulating anti-GEM antibody. Nine months af ter presentation he developed nephrotic range proteinuria and a repeat renal biopsy revealed membranous glomerulonephritis with no evidence of his original disease. Both the Goodpasture's associated HLA-DR2 and the membranous associated HLA-DR3 class II antigens were present. The association of antibody mediated and immune complex glomerulonephriti s is discussed, The simultaneous presence of HLA-DR2 and HLA-DR3 may p redispose to this association.