MRCEM Notes

Goodpasture's syndrome

Goodpasture's syndrome is rare condition associated with both pulmonary haemorrhage and rapidly progressive glomerulonephritis. It is caused by anti-glomerular basement membrane (anti-GBM) antibodies against type IV collagen. Goodpasture's syndrome is more common in men (sex ratio 2:1) and has a bimodal age distribution (peaks in 20-30 and 60-70 age bracket). It is associated with HLA DR2.

Features
  • pulmonary haemorrhage
  • followed by rapidly progressive glomerulonephritis

Factors which increase likelihood of pulmonary haemorrhage
  • smoking
  • lower respiratory tract infection
  • pulmonary oedema
  • inhalation of hydrocarbons
  • young males

Investigations
  • renal biopsy: linear IgG deposits along basement membrane
  • raised transfer factor secondary to pulmonary haemorrhages

Management
  • plasma exchange (plasmapheresis)
  • steroids
  • cyclophosphamide
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