What is anti-GBM disease?
Anti-glomerular basement membrane (anti-GBM) disease occurs when the immune system produces antibodies against a component of type IV collagen found in the basement membranes of the kidney filters (glomeruli) and the air sacs of the lungs. These antibodies trigger severe inflammation, causing rapidly progressive glomerulonephritis and, in many patients, diffuse alveolar haemorrhage. When both organs are involved the condition is often called Goodpasture's syndrome.
It is rare, with roughly one new case per million people each year. It tends to occur in two age peaks: young adults, who more often have lung bleeding, and older adults, who more often have kidney disease alone. Treatment is led jointly by respiratory medicine and nephrology.
Symptoms
Lung symptoms
- Coughing up blood, ranging from streaks to large amounts, although bleeding can be significant even without visible blood.
- Breathlessness and low oxygen levels.
- Cough and fatigue, often with anaemia.
Kidney symptoms
- Blood in the urine or dark, cola-coloured urine.
- Reduced urine output, swelling of the legs or face, and high blood pressure.
- Nausea, loss of appetite and tiredness as kidney function falls.
Symptoms can develop over days to weeks, and a preceding flu-like illness is common.
Causes and risk factors
Anti-GBM disease is autoimmune. It is not infectious and is not passed between people. Factors that increase risk or trigger lung bleeding include:
- Cigarette smoking: strongly linked to lung haemorrhage.
- Inhaled hydrocarbons and solvents.
- Recent respiratory infection.
- Inherited immune genes, particularly certain HLA types.
- Kidney injury from other causes, such as lithotripsy, and some immune-modulating drugs.
A proportion of patients also have ANCA antibodies (double-positive disease), which has features of vasculitis such as granulomatosis with polyangiitis and a higher chance of relapse.
How anti-GBM disease is diagnosed
Because delay can mean permanent kidney failure, tests are performed urgently, and treatment is often started on strong suspicion before all results are back.
| Test | What it shows |
|---|---|
| Anti-GBM antibody blood test | Circulating antibodies against the basement membrane |
| ANCA testing | Coexisting vasculitis (double-positive disease) |
| Urine tests and kidney function | Blood and protein in the urine and rising creatinine |
| Kidney biopsy | Linear antibody deposits along the glomerular basement membrane and crescent formation (the definitive test) |
| Chest X-ray and CT | Widespread shadowing from bleeding into the lungs |
| Bronchoscopy with lavage | Increasingly bloody washings confirming alveolar haemorrhage and excluding infection |
| Gas transfer (DLCO), when safe | A raised value suggesting fresh blood in the air spaces |
Other causes of lung bleeding, such as idiopathic pulmonary haemosiderosis, lupus and infection including tuberculosis, are considered alongside.
Treatment
Treatment follows KDIGO guidance and aims to remove the harmful antibodies and stop new ones being made.
Plasma exchange
Daily plasma exchange removes circulating anti-GBM antibodies and is continued until levels fall. It is particularly important when there is lung haemorrhage.
Immunosuppression
High-dose corticosteroids are combined with cyclophosphamide. Rituximab is sometimes used as an alternative. Steroids are tapered over several months.
Supportive care
Oxygen, blood transfusion and, in severe lung bleeding, intensive care with ventilation may be required. Dialysis is needed when kidney function is severely impaired. Infection prevention is important during immunosuppression.
Smoking cessation
Stopping smoking completely is essential, as continued smoking increases the risk of further lung bleeding.
Kidney transplantation
Patients with permanent kidney failure can be considered for kidney transplantation once antibodies have been undetectable for a sustained period.
Outlook and follow-up
Unlike many autoimmune diseases, anti-GBM disease usually does not return once treated, although double-positive patients relapse more often. Lung outcomes are generally good when bleeding is controlled. Kidney recovery depends heavily on how severe the damage is when treatment starts, which is why early recognition matters. Follow-up includes antibody levels, kidney function, blood counts and lung function. Patients in Hyderabad are managed at Apollo Hospitals, Financial District, with nephrology and critical care.
When to seek urgent care
Anti-GBM disease is a medical emergency. Go to hospital immediately if you cough up blood, become breathless, notice blood in the urine or very reduced urine output, or develop sudden swelling. During treatment, report fever or signs of infection promptly.
Frequently asked questions
Is Goodpasture's syndrome the same as anti-GBM disease?
The terms are often used interchangeably. Goodpasture's syndrome usually describes the combination of lung bleeding and kidney inflammation, while anti-GBM disease refers to the underlying antibody, which can affect the kidneys alone.
Why is plasma exchange needed?
Plasma exchange physically removes the harmful antibodies from the blood, while immunosuppressive drugs stop new antibodies being made. Together they protect the lungs and kidneys.
Will the disease come back?
Relapse is uncommon once antibodies have cleared, unlike many other autoimmune conditions. Patients who also have ANCA antibodies have a higher risk and need longer follow-up.
Does smoking matter?
Yes. Smoking is strongly linked to lung bleeding in anti-GBM disease. Stopping completely is one of the most important steps you can take.
Will I need dialysis?
Some patients need dialysis, especially if kidney damage is advanced at diagnosis. Some recover enough kidney function to stop, while others may later be considered for kidney transplantation.
Is it contagious or inherited?
No. It is an autoimmune condition. Certain inherited immune genes increase susceptibility, but it is not passed directly from parent to child.
Related conditions and procedures
Consult Dr. Gogineni Ratnakara Rao
Apollo Hospitals, Financial District: Monday to Saturday, 8:30 AM to 5:00 PM. Anything in Lung Clinic, Chanda Nagar: Monday to Saturday (Thursday closed), 6:00 PM to 9:00 PM.