Diagnostic Considerations

It is essential to promptly diagnose pulmonary hemorrhage, because this is the principal cause of early death in patients with in anti–glomerular basement membrane (anti-GBM) disease (Goodpasture disease).

When renal disease is present, it can then be isolated or accompanied by pulmonary hemorrhage. When significant renal disease is present, it usually progresses rapidly.

Essential mixed cryoglobulinemia should also be considered when evaluating a patient with suspected anti-GBM disease.

Differential Diagnoses

Behcet Syndrome
Hemosiderosis
IgA Vasculitis (Henoch-Schonlein Purpura)
Legionella Infection
Otolaryngologic Manifestations of Granulomatosis With Polyangiitis
Pediatric Mixed Connective Tissue Disease
Systemic Lupus Erythematosus

Workup

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Media Gallery

This image of direct immunofluorescence shows smooth linear staining of the basement membrane secondary to immunoglobulin G deposition. This confirms the diagnosis of anti-GBM disease (Goodpasture disease). Image courtesy of K. Orr, MD.

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Author

Rudolph P Valentini, MD Associate Professor of Pediatrics, Division of Pediatric Nephrology, Wayne State University School of Medicine; Vice President of Medical Affairs, Director of Dialysis Services, Children's Hospital of Michigan

Rudolph P Valentini, MD is a member of the following medical societies: American Academy of Pediatrics, American Society of Pediatric Nephrology, American Society of Nephrology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Girish D Sharma, MD, FCCP, FAAP Professor of Pediatrics, Rush Medical College; Director, Section of Pediatric Pulmonology and Rush Cystic Fibrosis Center, Rush Children's Hospital, Rush University Medical Center

Girish D Sharma, MD, FCCP, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, Royal College of Physicians of Ireland

Disclosure: Nothing to disclose.

Acknowledgements

Charles Callahan, DO Professor, Deputy Chief of Clinical Services, Walter Reed Army Medical Center

Charles Callahan, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American College of Osteopathic Pediatricians, American Thoracic Society, Association of Military Surgeons of the US, and Christian Medical & Dental Society

Disclosure: Nothing to disclose.

Girish D Sharma, MD Associate Professor of Pediatrics, Rush Medical College; Director, Section of Pediatric Pulmonology and Rush Cystic Fibrosis Center, Rush University Medical Center

Girish D Sharma, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, and Royal College of Physicians of Ireland

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.