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Antibodies to the basal membrane of the tubules in blood
Last reviewed: 05.07.2025
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Normally, antibodies to the glomerular basement membrane are absent in the blood serum.
The presence of antibodies to the glomerular basement membrane (anti-GBM) is most typical for patients with rapidly progressive glomerulonephritis (anti-GBM glomerulonephritis). All patients with anti-GBM glomerulonephritis can be divided into two groups: those with only renal pathology and Goodpasture's disease (50%), in whom the latter is combined with pulmonary pathology.
The antigens for the formation of anti-GBM are the C-terminal region of the α 3 -chain of type IV collagen, which is a component of the glomerular basement membrane (Goodpasture's Ag). Currently, there are many methods for determining anti-GBM - indirect immunofluorescence, ELISA (the most accessible), RIA.
Anti-GBM are found in 90-95% of patients with Goodpasture syndrome. Most patients with active anti-GBM glomerulonephritis have anti-GBM levels above 100 U. With effective treatment, anti-GBM levels decrease and they may disappear in 3-6 months. Some patients with rapidly progressing glomerulonephritis have anti-GBM and antinuclear antibodies in their blood (up to 40% of patients). This combination usually indicates a relatively favorable prognosis. Approximately 70% of patients with anti-GBM glomerulonephritis have antibodies to the renal tubular basement membrane, which cause the parallel development of tubulointerstitial nephritis.
Goodpasture's syndrome is a rare disease characterized by simultaneous rapidly progressive damage to the kidneys and lungs (pulmonary-renal syndrome) and associated with the formation of anti-GBM, which necessarily cross-react with antigens of the basal membrane of the pulmonary alveoli (containing an epitope of type IV collagen). Men aged 10-50 years are most often affected. Anti-GBM are detected in more than 90% of patients with Goodpasture's syndrome. The anti-GBM titer correlates with the activity of the process, so it is used to monitor the effectiveness of treatment.
Anti-GBM in serum is sometimes detected in patients with other forms of glomerulonephritis.
Determination of antibodies to the glomerular basement membrane, neutrophil cytoplasm, as well as antinuclear antibodies and CIC is indicated for all patients with primary rapidly progressive glomerulonephritis.
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