This reveals linear IgG deposits along the basement membrane. What is the most likely diagnosis?

A 25-year-old man has a renal biopsy due to worsening renal function. This reveals linear IgG deposits along the basement membrane. What is the most likely diagnosis?


Systemic lupus erythematous

IgA nephropathy

Minimal change disease

Post-streptococcal glomerulonephritis

Goodpasture’s syndrome

Goodpasture’s syndrome

Goodpasture’s syndrome is rare condition associated with both pulmonary haemorrhage and rapidly progressive glomerulonephritis. It is caused by anti-glomerular basement membrane (anti-GBM) antibodies against type IV collagen. Goodpasture’s syndrome is more common in men (sex ratio 2:1) and has a bimodal age distribution (peaks in 20-30 and 60-70 age bracket). It is associated with HLA DR2.

Features

  • pulmonary haemorrhage
  • followed by rapidly progressive glomerulonephritis

Factors which increase the likelihood of pulmonary haemorrhage

  • smoking
  • lower respiratory tract infection
  • pulmonary oedema
  • inhalation of hydrocarbons
  • young males

Investigations

  • renal biopsy: linear IgG deposits along the basement membrane
  • raised transfer factor secondary to pulmonary haemorrhages

Management

  • plasma exchange (plasmapheresis)
  • steroids
  • cyclophosphamide