A Possible Clue for the Production of Anti-Glomerular Basement Membrane Antibody Associated with Ureteral Obstruction and Hydronephrosis

Abstract

Background: Anti-glomerular basement membrane (anti-GBM) antibody-mediated glomerulonephritis (anti-GBM GN) is an autoimmune disease with rapidly progressive glomerulonephritis. Based on a case report of anti-GBM GN following hydronephrosis, we hypothesized that hydronephrosis may act as a trigger for the development of anti-GBM antibodies. Patients and Methods: We evaluated 11 patients who were diagnosed with hydronephrosis. It was measured with serum anti-GBM antibody. These patients' medical histories as well as risk factors for the development of anti-GBM antibodies and causes of hydronephrosis were reviewed. Renal function and hematuria were also considered. The serum anti-GBM antibody was measured with enzyme-linked immunosorbent assays (ELISA) or chemiluminescent enzyme immunoassays (CLEIA). Histopathological findings of renal biopsy specimens were also evaluated. Results: No patient had a medical history of renal disease. Five patients had a history of smoking. Ten of the 11 patients had renal dysfunction as evidenced by serum creatinine levels of 0.85-13.8 mg/dl, while 8 patients had RBCs in their urinary sediment at the time of diagnosis for hydronephrosis. Two of the patients assessed by ELISA and CLEIA were positive for anti-GBM antibodies. In 1 of these 3 patients, anti-GBM antibodies and renal dysfunction improved upon treatment for hydronephrosis. Another of the 3 patients developed anti-GBM GN, but anti-GBM antibodies and renal dysfunction improved dramatically upon treatment. In the 3rd patient without improved hydronephrosis, anti-GBM antibodies and renal dysfunction remained unchanged. Conclusion: Our results provide insights into the development of anti-GBM antibodies in patients with ureteral obstruction and hydronephrosis.

Anti-Glomerular Basement Membrane Disease Following Nephrectomy

“…3 of these patients had elevated anti-GBM antibody titers. In 1 patient, anti-GBM antibody levels returned to normal after treatment of hydronephrosis [7]. This study, although small, lends support to the paradigm that disruption of the collagen hexamer and cryptic antigen exposure is necessary to induce disease.…”

The clinical and immunological features of the post-extracorporeal shock wave lithotripsy anti-glomerular basement membrane disease

“…Anti-GBM diseases were also reported scarcely to associate with obstructive uropathy due to urinary malignancy, neurogenic bladder, or ureteral stenosis [ 15–18 ]. The anti-GBM antibody level and renal function seemed to be parallel with treatment efficacy of hydronephrosis [ 18 ]. Intact NC1 hexamer could be detected in the serum and be secreted in the urine of healthy individuals [ 17 , 42 ].…”