Short AK, Esnault VLM, Lockwood CM
ANCA and anti-GBM antibodies: two coexisting distinct autoreactivities detectable in patients with rapidly progressive glomerulonephritis

Am J Kidney Dis (Sep) 26:439-445 1995

Some patients with anti-GBM disease have coexisting ANCA. 19,000 plasma samples from patients with suspected autoantibody-associated nephritis or vasculitis were tested for ANCA and anti-GBM. 160 pts were + for anti-GBM and 1390 pts were + for ANCA; 34 (21%) of pts with anti-GBM also had ANCA; using ELISA, 73.5% of these ANCA were specific for myeloperoxidase (as opposed to 37% specificity to myeloperoxidase in pts with ANCA alone). Immunofluorescent techniques (i.e., determination of C-ANCA or P-ANCA) were not reliable in determining ANCA specificity. By using cross-inhibition, ELISA, and Western blot assays, these were shown to be two distinct populations of autoantibodies. It is possible that the ANCA response precedes the development of anti-GBM disease, the latter occurring in pts with the haplotype DRw2 (however, it is also possible for ANCA to develop after anti-GBM). Management should take into account the frequent clinical relapses of ANCA-positive disease. (Leehey)

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Proteinuria/Hematuria : Vasculitis (Wegener's PAN, etc.)
ARF etiology : Acute glomerulonephritis/RPGN