Question:
A 51-year-old person came with a complaint of hematuria. On examination he was normotensive and had pedal edema. Investigations revealed the patient had no glucosuria and had a creatinine value of 9 mg%. The renal biopsy is as shown below. Which of the following investigations should one do to identify the etiology of the disease?
A 51-year-old person came with a complaint of hematuria. On examination he was normotensive and had pedal edema. Investigations revealed the patient had no glucosuria and had a creatinine value of 9 mg%. The renal biopsy is as shown below. Which of the following investigations should one do to identify the etiology of the disease?
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Linear IgG along the basement membrane on immunofluorescence has one signature antibody.
Updated On: Jun 23, 2026
- ANA
- Anti-GBM antibodies
- HIV RNA
- Urine immunoelectrophoresis
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The Correct Option is B
Solution and Explanation
Step 1: The clinical picture is a rapidly progressive nephritic syndrome: hematuria, edema and a sharply raised creatinine (9 mg%) signalling renal failure.
Step 2: The biopsy shows linear staining of the glomerular basement membrane with IgG on immunofluorescence. Smooth, continuous linear deposition is characteristic of anti-glomerular basement membrane (anti-GBM) disease, also called Goodpasture syndrome.
Step 3: The confirmatory test for the etiology is detection of circulating anti-GBM antibodies. These antibodies cause endothelial injury and a crescentic glomerulonephritis. ANA would be ordered for lupus (granular, full-house deposits), urine immunoelectrophoresis for myeloma, and HIV RNA for HIV-associated nephropathy, none of which give linear IgG.
Answer: Anti-GBM antibodies.
Ref: Robbins & Cotran Pathologic Basis of Disease, 9e, p 912-914.
Step 2: The biopsy shows linear staining of the glomerular basement membrane with IgG on immunofluorescence. Smooth, continuous linear deposition is characteristic of anti-glomerular basement membrane (anti-GBM) disease, also called Goodpasture syndrome.
Step 3: The confirmatory test for the etiology is detection of circulating anti-GBM antibodies. These antibodies cause endothelial injury and a crescentic glomerulonephritis. ANA would be ordered for lupus (granular, full-house deposits), urine immunoelectrophoresis for myeloma, and HIV RNA for HIV-associated nephropathy, none of which give linear IgG.
Answer: Anti-GBM antibodies.
Ref: Robbins & Cotran Pathologic Basis of Disease, 9e, p 912-914.
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