Glomerulonephritis with coexistent immune deposits and antibasement membrane activity

Six patients with coexistent antiglomerular basement membrane disease and granular immunoreactants in the glomerular basement membrane and mesangium are discussed. These six patients represent 35% of all patients with antiglomerular basement membrane nephritis examined over 10 years. All patients presented with acute, oliguric renal failure, and rapid deterioration in renal function. In all patients the pathogenetic role of the antiglomerular basement membrane antibody was confirmed by the demonstration of linear deposits of IgG along the glomerular basement membrane and antiglomerular basement membrane antibody activity in the serum or renal eluates, or both. Evidence for the existence of concurrent immune aggregates was obtained by immunofluorescence studies and electron microscopy. Radioimmunoassays, which were performed in two patients to detect circulating immune complexes, however, yielded negative results. The possible mechanisms concerned in the evolution of this condition and their potential implications are reviewed.