Human Anti-Glomerular-Basement Nephritis

Argument for the Classical Concept:

In a special type of glomerulonephritis, the so-called anti-glomerular-basement-membrane (anti-GBM) nephritis, antibodies against the glomerular basement membranes (shortened GBM) are found in the blood of the patients during active periods of the disease. By immunofluorescence microscopy such antibodies are also found lying closely to the GBM as a linear band. These findings strongly suggest that the attack of the antibodies on the GBM is the cause of the disease.

Counter-Argument

Anti-GBM antibodies are found now and then in the blood and even in the kidneys of healthy individuals without any clinical signs of glomerulonephritis (Zimmerman et al 1979, Bailey et al 1981, Bernard et al 1986).They have also been found in the blood of transplanted patients whose own kidneys allegedly have been destroyed by anti GBM-nephritis (Couser et al 1973). But although the same antibodies still were present in the blood and even located in the transplanted kidney, the latter was completely normal. As these anti-GBM antibodies were blamed for having destroyed the patient´s own kidneys, but did not harm the transplanted kidney, an attack of such antibodies alone cannot explain the serious disease.

An important co-factor must be necessary, a factor that was present when the patient became sick, but was absent after the transplantation. The factor may for instance have been an exposure to nephrotoxic chemicals. In accordance, a large numer of case stories have been published where anti-GBM nephritis had been preceded by heavy exposure to various kinds of toxic chemicals closely time-asociated with the acute onset of the disease.

(In fact, most of the published case histories of glomerulonephritis associated with toxic exposure concern this very rare type of glomerulonephritis. This fact has of course been used by those who are skeptic to the association in general. How come that this rare variant predominates among the case stories? Why haven’t more case histories about exposed patients with the common variants of glomerulonephritis been published? The reason is simple. Anti-GBM nephritis is very often followed by lung bleedings, the so-called Goodpasture´s syndrome. A patient with glomerulonephritis and lung bleedings automatically stimulates the doctor to ask for toxic airborn exposure. Unfortunately, few doctors asks patients with glomerulonephritis alone.)