Patients with rapidly progressive glomerulonephritis may initially present with vague, non-specific symptoms such as body aches and pains, pallor, peripheral edema, lethargy, and/or fatigue [1]. Conversely, patients may present with more renal specific symptoms including hematuria, anemia, oliguria, hypertension, and/or peripheral edema [2]. An elevated serum creatinine and renal insufficiency is almost always a presenting feature. The most frequently occurring prodrome of ANCA-associated vasculitis, including rapidly progressive glomerulonephritis, consists of flulike symptoms (e.g., fever, body aches, loss of appetite, chills, weight loss, malaise) [3]. Following this prodrome, patients may develop abdominal pain, a migratory polyarthropathy, and cutaneous ulcerations and/or nodules. Patients may also present with symptoms of sinusitis, cough, and/or hemoptysis when there is pulmonary involvement [4]. Patients with immune-related rapidly progressive glomerulonephritis, such as anti-GBM disease in which the patient has antibodies directed against the alveolar basement membranes, may present with extra-renal symptoms such as hemoptysis and pulmonary hemorrhage. Subsequently, the pulmonary bleeding may result in anemia, iron deficiency, pallor, and weakness.

• Rapidly Progressive Glomerulonephritis

  C3 and C4 complement levels are usually either normal or slightly elevated in patients with rapidly progressive glomerulonephritis type I and III. Circulating anti-GBM antibodies are present in type I rapidly progressive glomerulonephritis. [symptoma.com]

  Rapidly progressive glomerulonephritis Other names Crescentic glomerulonephritis[1] Histopathological image of crescentic glomerulonephritis in a patient with MPO-ANCA positive rapid progressive glomerulonephritis. Hematoxylin & eosin stain. [en.wikipedia.org]

  This article also only focuses on the adult population affected by rapidly progressive glomerulonephritis. [emedicine.medscape.com]

  Anti-glomerular basement membrane (anti-GBM) antibodies are the hallmark of anti-GBM disease, which is characterized by rapidly progressive glomerulonephritis. [ncbi.nlm.nih.gov]

  […] acute RPGN, rapidly progressive acute glomerulonephritis, Glomerulonephritis rapidly progressive, rapidly progressive glomerulonephritis, Rapidly progressive glomerulonephritis, RPGN - Rapidly progressive glomerulonephritis, Rapidly progressive glomerulonephritis [fpnotebook.com]

• Anemia

  Conversely, patients may present with more renal specific symptoms including hematuria, anemia, oliguria, hypertension, and/or peripheral edema. An elevated serum creatinine and renal insufficiency is almost always a presenting feature. [symptoma.com]

  Laboratory investigation displayed normochromic anemia with negative Coombs' test. Immunological studies were positive for rheumatoid factor and circulating immune complex. [ncbi.nlm.nih.gov]

  […] progressive glomerulonephritis acute glomerulonephritis marked by a rapid progression to end-stage renal disease and histologically by profuse epithelial proliferation, often with epithelial crescents; principal signs are anuria, proteinuria, hematuria, and anemia [medical-dictionary.thefreedictionary.com]

• Fatigue

  She was admitted to our hospital because of general fatigue, exertional dyspnea, and peripheral edema. Her serum level of creatinine was increased (4.4 mg/dL), and her hemoglobin concentration was reduced (8.0 g/dL). [ncbi.nlm.nih.gov]

  Patients with rapidly progressive glomerulonephritis may initially present with vague, non-specific symptoms such as body aches and pains, pallor, peripheral edema, lethargy, and/or fatigue. [symptoma.com]

  Other common symptoms include Cough Dyspnea Fatigue Fever Hematuria Weight loss Up to 40% of patients have gross hematuria, although pulmonary hemorrhage may precede renal manifestations by weeks to years. [msdmanuals.com]

  Systemic features (i.e. malaise, fatigue, mild fever, pallor, weight loss) have been reported. [orpha.net]

• Collapse

  Note the collapsed glomerular tufts and the crescent-shaped mass of proliferating cells and leukocytes internal to Bowman capsule. [medicinembbs.blogspot.com]

  Herein, we report a case of acute kidney injury (AKI) due to diarrhea-induced acute tubular necrosis (ATN) in a patient with nephrotic syndrome secondary to biopsy-proven collapsing focal and segmental glomerulosclerosis (FSGS). [ncbi.nlm.nih.gov]

  […] glomerular circumference, 70% of glomeruli Microscopic (histologic) description Crescents in glomeruli are proliferation of parietal epithelium of Bowman’s capsule with macrophages, neutrophils, lymphocytes, fibrin and collagen Also see glomerular capillary collapse [pathologyoutlines.com]

   In the tuft (in addition to necrosis) capillary collapse, mesangial matrix increase, and karyorrhexis can be identified.  Frequently there is segmental or extensive destruction of Bowman’s capsule in these cases it is usual to find granulomas and [slideshare.net]

  The glomerular tuft usually appears hypocellular and collapses. Necrosis within the tuft or involving the crescent may occur and may be the most prominent abnormality. In such patients, histologic evidence of vasculitis should be sought. [merckmanuals.com]

• Anorexia

  Symptoms and Signs Manifestations are usually insidious, with weakness, fatigue, fever, nausea, vomiting, anorexia, arthralgia, and abdominal pain. [merckmanuals.com]

  […] nephropathy.2–4 Culturally, African Americans, Hispanics, Pacific Islanders, American Indians, and adults older than age 60 are at greater risk for the development of CKD compared with Caucasians and northern Asian groups.2,3 Presenting symptoms include anorexia [fadavispt.mhmedical.com]

  Twenty-two days after the last renal function testing, he developed low-grade fever, anorexia, nausea, and vomiting. He noted one episode of gross hematuria and became abruptly oligoanuric. [cambridge.org]

  2: Amyloid deposits are strongly positive for amyloid A protein (a), and lack of light chain restriction with kappa (b) and lambda (c) light chains (40×, Immunoperoxidase) Click here to view He returned for follow-up after 1 month with complaints of anorexia [indianjnephrol.org]

• Hemoptysis

  Patients may also present with symptoms of sinusitis, cough, and/or hemoptysis when there is pulmonary involvement. [symptoma.com]

  If the patient presents with hemoptysis, pulmonary-renal syndrome should be suspected. RPGN requires rapid diagnosis and immediate initiation of immunosuppressive therapy to prevent irreversible kidney damage. [amboss.com]

  Abstract Smoking in young men may trigger anti-GBM disease manifesting with hemoptysis. [unboundmedicine.com]

  respiratory failure or pulmonary hemorrhage Renal: glomerulonephritis Hematuria, proteinuria, RBC casts Symptoms are often rapidly progressive Differential Diagnosis Hemoptysis Infectious Bronchitis Pneumonia Lung abscess Tuberculosis Plague Aspergilloma [wikem.org]

  Symptoms are dyspnea, cough, fatigue, hemoptysis, and hematuria. Goodpasture syndrome is suspected in patients with hemoptysis or hematuria and is confirmed by the presence of anti-GBM antibodies in the blood or in a renal biopsy specimen. [msdmanuals.com]

• Dyspnea

  She was admitted to our hospital because of general fatigue, exertional dyspnea, and peripheral edema. Her serum level of creatinine was increased (4.4 mg/dL), and her hemoglobin concentration was reduced (8.0 g/dL). [ncbi.nlm.nih.gov]

  Other common symptoms include Cough Dyspnea Fatigue Fever Hematuria Weight loss Up to 40% of patients have gross hematuria, although pulmonary hemorrhage may precede renal manifestations by weeks to years. [msdmanuals.com]

  She had fever, cough, severe dyspnea and lately hemoptysis and severe hypoxia with bilateral alveolar opacity in chest imaging, with no response to broad spectrum antibiotic. [caspjim.com]

• Loss of Appetite

  The most frequently occurring prodrome of ANCA-associated vasculitis, including rapidly progressive glomerulonephritis, consists of flulike symptoms (e.g., fever, body aches, loss of appetite, chills, weight loss, malaise). [symptoma.com]

  The first signs may be paleness, fatigue, loss of appetite, nausea and weakness. [davita.com]

  Patients may also report loss of appetite. This may be followed, sometimes very rapidly, by pulmonary manifestations. These may precede or occur simultaneously with renal involvement, and include breathlessness, coughing and hemoptysis. [news-medical.net]

  Loss of appetite, fatigue, and weakness are common early symptoms. [medlineplus.gov]

  Symptoms can include: headaches nausea and vomiting sleepiness weakness on one side of your body memory loss problems with speech and language personality and mood changes muscle weakness double vision or blurred vision loss of appetite seizures Keep [healthline.com]

• Abdominal Pain

  Following this prodrome, patients may develop abdominal pain, a migratory polyarthropathy, and cutaneous ulcerations and/or nodules. Patients may also present with symptoms of sinusitis, cough, and/or hemoptysis when there is pulmonary involvement. [symptoma.com]

  He complained of abdominal pain and papulopustular skin lesions. Multiple ulcers were seen on the colon on colonoscopy. Routine renal work-up revealed heavy proteinuria and hematuria. Renal biopsy demonstrated crescentic glomerulonephritis. [ncbi.nlm.nih.gov]

  […] symptoms of glomerulonephritis are: Blood in the urine (dark, rust-colored, or brown urine) Foamy urine (due to excess protein in the urine) Swelling (edema) of the face, eyes, ankles, feet, legs, or abdomen Symptoms may also include the following: Abdominal [medlineplus.gov]

• Petechiae

  Oral ulcer or butterfly rash is indicative of lupus Skin petechiae may indicate lupus or vasculitis Evidence of atheroembolic disease Upper Respiratory tract involvement – sinuses* RS – signs of asthma/alveolar hmghe CNS- peripheral neuropathy 13 [slideshare.net]

  No petechiae, ecchymosis or costovertebral angle tenderness were noted. Blood tests showed leukocytosis, azotemia (BUN: 159 mg/dL, creatinine: 21.1 mg/dL), hyperkalemia, and anion gap metabolic acidosis. [revistanefrologia.com]

• Arthralgia

  Linear staining of GBM with IgG -Presents typically in the 6th-7th decade of life as acute glomerulonephritis with a nephritic syndrome including RBC casts, dysmorphic RBCs -Oliguria or anuria -Mild proteinuria -May have arthralgias or myalgias -Absence [studyblue.com]

  At the time of consultation he suffered from uveitis and generalized arthralgias. The serum creatinine was 14 mg/dl and urinalysis showed 4+ protein and microscopic hematuria. Results of serological tests were normal. [ncbi.nlm.nih.gov]

  Fever, arthralgia Arthralgia Pain in the joint. Rheumatic Fever, and weight loss Weight loss Decrease in existing body weight. Bariatric Surgery may also be present. [lecturio.com]

  Symptoms and Signs Manifestations are usually insidious, with weakness, fatigue, fever, nausea, vomiting, anorexia, arthralgia, and abdominal pain. [merckmanuals.com]

• Osteoporosis

  Such an example is the presence or occurrence of osteopenia/osteoporosis in patients with SCN ( Fewtrell et al, 1997 ). [onlinelibrary.wiley.com]

  […] are on dialysis therapy [8]) including sepsis, thrombosis, infertility (cyclophosphamide) malignancy-bladder (cyclophosphamide), cervical dysplasia, antiphospholipid antibody syndrome, hypercholesterolemia and coronary heart disease, cytopenia (AZA) osteoporosis [peertechz.com]

  Comprehensive health information about cancer, osteoporosis, high blood pressure and more. Comprehensive health information including health news updates and health resources. [web.archive.org]

  Side effects The medications used to treat anti-GBM/Goodpasture’s syndrome have potentially serious side effects, such as lowering your body’s ability to fight infection, and potential bone loss (osteoporosis), among others. [vasculitisfoundation.org]

• Lethargy

  Patients with rapidly progressive glomerulonephritis may initially present with vague, non-specific symptoms such as body aches and pains, pallor, peripheral edema, lethargy, and/or fatigue. [symptoma.com]

  Initial symptoms may include: fatigue, weakness, or lethargy nausea or vomiting loss of appetite unhealthy, pale appearance When the disease affects your lungs, the following symptoms may occur: dry cough coughing up blood (hemoptysis) shortness of breath [healthline.com]

  Symptoms Early symptoms include general body aches and pains, fatigue, weakness or lethargy, pale skin, nausea, lack of appetite, and shortness of breath. [vasculitisfoundation.org]

  When severe, patient can demonstrate symptoms of uremia, such as nausea, vomiting, fatigue, confusion, lethargy, and/or coma.3,9 Pulmonary symptoms are often seen at initial presentation with hemoptysis ranging from minimal to massive leading to respiratory [emdocs.net]

  The following are the most common: headache and lethargy (generally upon awakening in the morning) seizures, depending on tumor type and location compression of surrounding brain structures. [danafarberbostonchildrens.org]

• Kidney Failure

  We report a case of rapidly progressive kidney failure with kidney biopsy showing crescentic GN on light microscopy and immunofluorescence showing linear/globular glomerular basement membrane (GBM) staining for immunoglobulin G and C3, consistent with [ncbi.nlm.nih.gov]

  If left untreated, it rapidly progresses into acute kidney failure[7] and death within months. [en.wikipedia.org]

  Coexisting Diseases and Conditions Hemoptysis, dyspnea, hypertension, arthritis, anemia, acute kidney failure, chronic kidney disease, heart disease, and respiratory failure. Sources Article Sources and Footnotes Goodpasture Syndrome. (n.d.-a). [autoimmuneinstitute.org]

• Oliguria

  Rapidly progressive ("crescentic") glomerulonephritis is a primary glomerulonephritis, which produces nephritic syndrome (hematuria, oliguria, uremia, hypertension and mild proteinuria). [pathologyatlas.ro]

  Progressive decline in GFR over weeks to months (more subacute presentation) -Rapid loss of renal function over weeks to months -Often accompanied with oliguria or anuria -Urinalysis shows dysmorphic RBCs, RBC casts, with or without proteinuria Rapidly [studyblue.com]

  Conversely, patients may present with more renal specific symptoms including hematuria, anemia, oliguria, hypertension, and/or peripheral edema. An elevated serum creatinine and renal insufficiency is almost always a presenting feature. [symptoma.com]

  And in this case, despite oliguria and rapid deterioration of renal function, the renal function recovered partially and continued to be stabilized with a favourable response to hemodialysis and combined system immunosuppressive therapy. [ncbi.nlm.nih.gov]

  It is characterised clinically by rapid deterioration of renal function, nephritic syndrome and severe oliguria. Untreated, it can lead to death within weeks to months. [renalpathology.wordpress.com]

• Renal Insufficiency

  Conversely, patients may present with more renal specific symptoms including hematuria, anemia, oliguria, hypertension, and/or peripheral edema. An elevated serum creatinine and renal insufficiency is almost always a presenting feature. [symptoma.com]

  On the other hand, fibrillary glomerulonephritis (GN) typically presents as proteinuria, hematuria and renal insufficiency, but rarely as RPGN. [mayoclinic.pure.elsevier.com]

  They developed proteinuria, hematuria, renal insufficiency, and anemia, and D-PC was stopped. On admission, MPO-ANCA was strongly positive in their sera. Renal biopsy showed glomerulonephritis with cellular crescents. [ncbi.nlm.nih.gov]

  Clinical outcomes of 12 patients were complete remission in 1(8%), end-stage renal disease in 2(17%), chronic renal insufficiency with persistent proteinuria in 2(17%), and normal renal function with persistent proteinuria in 7(58%) at the last follow-up [chikd.org]

• Uremia

  Rapidly progressive ("crescentic") glomerulonephritis is a primary glomerulonephritis, which produces nephritic syndrome (hematuria, oliguria, uremia, hypertension and mild proteinuria). [pathologyatlas.ro]

  The clinical course was brief, lasting from 5 to 27 weeks, and resulted in death from uremia and congestive heart failure. [annals.org]

  […] doses of corticosteroids may lead to recovery of renal function. rap·id·ly pro·gress·ive glo·mer·u·lo·ne·phri·tis glomerulonephritis usually presenting insidiously, without preceding streptococcal infection, with increasing renal failure leading to uremia [medical-dictionary.thefreedictionary.com]

• Renal Function Impairment

  BACKGROUND: Idiopathic IRPGN is a form of renal vasculitis in which a high chronicity index is present despite minimal impairment of renal function. [ncbi.nlm.nih.gov]

  This study corresponds with other reports according to which the degree of renal function impairment at presentation inversely correlates with the response to the treatment and the subsequent renal outcome [3–12]. [bmcnephrol.biomedcentral.com]

Blood chemistry and serologic tests should be ordered 'stat' on any patient suspected of having rapidly progressive glomerulonephritis. If clinically indicated, a renal biopsy may also be performed.

Blood serum test results will consist of an elevated creatinine level usually exceeding 3 mg/dL, decreased glomerular filtration rate, elevated erythrocyte sedimentation rate, and C-reactive protein [5]. Complete blood count with differential will show an elevated neutrophil count and thrombocytes. A urinalysis will usually show dysmorphic hematuria, casts, and proteinuria.

Serologic testing should include the following: ANCA, anti-glomerular basement membrane antibodies, anti-dsDNA antibody, complement assays, antinuclear antibodies, and others as indicated from the clinical history, examination, and biopsy results [6]. C3 and C4 complement levels are usually either normal or slightly elevated in patients with rapidly progressive glomerulonephritis type I and III. Circulating anti-GBM antibodies are present in type I rapidly progressive glomerulonephritis. Most patients with type III disease are positive for myeloperoxidase (MPO)–ANCA [3].

A kidney biopsy can be used to achieve the diagnosis of various types of rapidly progressive glomerulonephritis (types I, II, III). A microscopic examination of renal tissue will show crescentic glomerulonephritis [7]. Crescent formation is a result of a response to injury to the glomerular capillary walls [8]. The extent of crescent formation is correlated with the disease severity; patients that have crescent formations in less than half of their glomeruli are likely to have a mild disease course and full recovery, whereas those with greater than three-quarters of glomeruli present with advanced renal failure that is refractory to therapy [9].

Chest X-ray and/or chest computed tomography (CT) may be useful for patients with vasculitis and Goodpasture syndrome [7] [10]. Patients may have a normal/negative chest X-ray and a chest CT that shows reticulonodular infiltrates. An abdominal and renal ultrasound can be used to evaluate echogenicity, renal atrophy or enlargement, and rule out obstruction [11].

• Leukopenia

  Serum creatinine (renal function) Hemoglobin (falls in pulmonary hemorrhage) Anti-GBM antibody levels Chest X-rays KCO (reduced in pulmonary hemorrhage) Monitoring adverse effects of the drug regimen Total white cell count (cyclophosphamide may induce leukopenia [news-medical.net]

  Cyclophosphamide 1.5 to 2 mg/kg orally once a day is usually given and may particularly benefit antineutrophil cytoplasmic antibody (ANCA)-positive patients; monthly pulse regimens may cause fewer adverse effects (eg, leukopenia, infection) than oral [merckmanuals.com]

  Since the lower cumulative dose of the pulse cyclophosphamide regimen reduces the rate of infectious complications, leukopenia, and gonadal toxicity, oral prednisolone plus pulse cyclophosphamide is the preferred regimen by many centers. [28],[29] Whether [sjkdt.org]

  […] cannot be ruled out, thus conferring increased risk by addition of immunosuppressive agents, dialysis-dependent patients, elderly patients (particularly those older than 70 years), and those in whom immunosuppressive agents are contraindicated because of leukopenia [ncbi.nlm.nih.gov]

• Hypoalbuminemia

  The patient was diagnosed with nephrotic syndrome characterized by high range proteinuria (protein 3630 mg/day), hypoalbuminemia, (serum albumin of 1.7 g/dL), hyperlipidemia (cholesterol 276 mg/dL, triglycerides 366 mg/dL) and edema. [peertechz.com]

  Nephrotic syndrome Some glomerular diseases present with nephrotic syndrome, which is characterized by massive proteinuria, leading to hypoalbuminemia and edema (see Nephrotic vs. [pathologystudent.com]

• Creatinine Increased

  The initial presentation usually is with oliguria, creatinine increase, variable proteinuria, macro or microhematuria, and arterial hypertension. Occasionally there is nephrotic syndrome. [kidneypathology.com]

• Creatinine Increased

  The initial presentation usually is with oliguria, creatinine increase, variable proteinuria, macro or microhematuria, and arterial hypertension. Occasionally there is nephrotic syndrome. [kidneypathology.com]

• Leukocytosis

  Laboratory analysis showed leukocytosis with a left shift, severe lactic acidosis, and negative anti-membrane antibodies, anti-nuclear antibodies, anti-neutrophil cytoplasmic antibodies, immunocomplexes, anti-DNA, anti-SS-A, anti-SS-B, anti-RNP, and anti-Scl [revistanefrologia.com]

  Investigations Blood tests FBC: iron-deficiency anaemia from intrapulmonary bleeding, leukocytosis. Renal function and electrolytes: watch for renal failure. [patient.info]

  On CBC, anemia is usually present, and leukocytosis is common. [merckmanuals.com]

Even though anti-GBM serology tests are often delayed, treatment for anti-GBM antibody disease should be delayed until the tests are recieved and the diagnosis is definitive False, time is crucial in patients with anti-GBM antibody disease and treatment [studyblue.com]

Progression to renal failure is rapid without treatment.. [geekymedics.com]

Several new treatment strategies, such as leukocytaphereis (LCAP) and intravenous immunoglobulin (IVIg), have become available and these treatments have made it possible to treat high-risk RPGN patients without inducing serious immunosuppressive states [genome.jp]

The prompt discontinuation of D-penicillamine and vigorous treatment measures could allow for a good prognosis as in this case. [ncbi.nlm.nih.gov]

Specialty Nephrology Symptoms Hematuria[2] Types Type I, II and III[3] Diagnostic method Serum analysis[2] Treatment Corticosteroids and Cyclophosphamide[4] Rapidly progressive glomerulonephritis (RPGN) is a syndrome of the kidney that is characterized [en.wikipedia.org]

The prognosis for patients with anti-GBM antibody disease is poor. [ncbi.nlm.nih.gov]

Poor prognosis – most progress to end stage renal failure Rapidly progressive glomerulonephritis (crescentic) Also known as crescentic glomerulonephritis. Carries poor prognosis – rapid progression to kidney failure over weeks. [geekymedics.com]

The prognosis is severe, with rapid and irreversible evolution to renal failure. Etiology of rapidly progressive crescentic glomerulonephritis : streptococcal infection, systemic lupus, vasculitis, Goodpasture's syndrome, idiopathic. [pathologyatlas.ro]

Etiology of rapidly progressive crescentic glomerulonephritis : streptococcal infection, systemic lupus, vasculitis, Goodpasture's syndrome, idiopathic. [pathologyatlas.ro]

The most common underlying etiologies were post-infectious glomerulonephritis (PIGN) (63.2%) and lupus nephritis (21.1%). [ncbi.nlm.nih.gov]

Abstract Summary: The clinical course and outcome of rapidly progressive glomerulonephritis (RPGN) of variable etiology are not well defined in children. [nature.com]

Epidemiology[edit] The incidence rate of rapidly progressive glomerulonephritis is approximately 3.9 individuals per million.[11] References[edit] ^ RESERVED, INSERM US14-- ALL RIGHTS. [en.wikipedia.org]

The case presentation is followed by a brief overview of the epidemiology of AKI in nephrotic syndrome as well as a discussion of its risk factors and potential mechanisms involved. [ncbi.nlm.nih.gov]

Updated: Sep 25, 2008 ^ "rapidly progressive glomerulonephritis" at Dorland's Medical Dictionary ^ "Rapidly Progressive Glomerulonephritis: Background, Pathophysiology, Epidemiology". 2018-04-05. ^ Morita T, Suzuki Y, Churg J (1973). [en.wikipedia.org]

There are three different pathophysiological mechanisms that can result in RPGN: anti-glomerular basement membrane antibody disease (Goodpasture syndrome), immune complex glomerulonephritis (e.g., lupus nephritis), and glomerulonephritis associated with [amboss.com]

Understanding the pathophysiology and complex management of this disease poses challenges to clinicians. CASE REPORT: A 42-year-old woman presented with acute renal and hepatic failure. She had been on PTU for 11 months for Graves' disease. [ncbi.nlm.nih.gov]

Prevention & Expectations What can be done to prevent the disease? Depending on the cause, some cases of RPGN may be prevented. [odlarmed.com]

Abstract Rapidly progressive glomerulonephritis (RPGN) must be diagnosed and treated quickly to prevent irreversible organ injury. [ncbi.nlm.nih.gov]

Secondary Prevention Cost-Effectiveness of Therapy Future or Investigational Therapies Case Studies Case #1 Goodpasture syndrome On the Web Most recent articles Most cited articles Review articles CME Programs Powerpoint slides Images American Roentgen [wikidoc.org]

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6. Lerner RA, Glassock RJ, Dixon FJ. The role of anti-glomerular basement membrane antibody in the pathogenesis of human glomerulonephritis. J Exp Med 1967;126: 989-1004.
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10. Phelps RGRees AJ. The HLA complex in Goodpasture's disease: a model for analyzing susceptibility to autoimmunity.Kidney Int.1999;56: 1638-53.
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