Presence of glomerular basement membrane (GBM) antibodies in HIV− patients with Pneumocystis carinii pneumonia

Abstract

SUMMARYFollowing the unexpected finding of antibodies to GBM in a patient with Pneumocystis carinii pneumonia in the absence of kidney abnormalities, the presence of anti-GBM antibodies was analysed in 14 patients with pulmonary P. carinii infection who did not have clinical evidence of autoimmune glomerulonephritis. Patients were divided into three groups: HIV ¹ with P. carinii pneumonia (n ¼ 4), HIV + with P. carinii pneumonia (n = 5) and HIV ¹ carriers of P. carinii without pneumonia (n = 5). As control groups, HIV ¹ patients with community-acquired non-P. carinii pneumonia (n = 6) and healthy individuals (n = 16) were included. Anti-GBM antibodies, studied with a quantitative enzyme immunoassay (EIA) for anti-a3 chain of collagen IV antibodies, were detected in three out of the four HIV ¹ patients with P. carinii pneumonia, but not in any individuals of the other categories. These results suggest that P. carinii alveolar injury or the host response to the organism could affect the basal membrane Goodpasture antigen or a similar antigen, and induces anti-GBM antibody production in HIV ¹ patients, and support the hypothesis that, at least in some cases, Goodpasture's syndrome could be triggered by an alveolar lesion induced by a P. carinii pneumonia.

Pulmonary renal syndrome: treatment of acute renal failure secondary to double positive goodpasture syndrome

“…5,6 That is the reason our patient was on prophylaxis for this on Trimethoprim sulphamethoxazole after discharge. Increasing evidence showed that genetic factors are associated with goodpasture disease.…”

Anti-Glomerular Basement Membrane Glomerulonephritis with Subsequent Pulmonary Hemorrhage in the Course of Pulmonary Tuberculosis

“…7 A recent study showed that Goodpasture's disease could be incited by Pneumocystis carinii pneumonia. 8 Exposure to hydrocarbons has been associated with the onset of symptoms, and case-control studies have shown higher levels of anti-GBM antibodies in individuals exposed to inhaled hydrocarbons. 9 Cigarette smoking has frequently been reported in association with the development of disease, and disease relapses have been temporally linked with episodes of smoking.…”

Anti-glomerular basement membrane glomerulonephritis in an HIV positive patient: case report

“…The antigen involved is the α3 chain of type IV collagen, the main structural component of the glomerular basement membrane. The antigenic region of the molecule is the 230 amino acid non-collagen domain called NC1, in the carboxyl terminal region [1,2,25].…”

“…Calderon et al [1] detected anti-GBM antibodies, with evidence of anti-GBM glomerulonephritis, in HIV-negative patients with Pneumocystis carinii lung infection, and not in HIV-negative patients who carried the pathogen but did not have pneumonia, which suggested that the alveolar lesion caused by the agent is responsible for the development of the autoimmune disease. Moreover, HIV-positive patients with P. carinii pneumonia did not present anti-GBM antibodies.…”

“…Goodpasture's syndrome includes glomerulonephritis, lung hemorrhage and glomerular basement membrane antibodies (GBM) [1]. Lung hemorrhage occurs in 50 to 70% of the cases, with greater incidence in smokers.…”