DDx
Diagnostic Considerations
Goodpasture syndrome is not the only cause of the pulmonary-renal syndrome (ie, kidney failure, lung hemorrhage). Other important causes of pulmonary-renal symptoms include the following:
-
Severe cardiac failure complicated by pulmonary edema (often manifesting as blood-tinged sputum) and prerenal azotemia
-
Kidney failure from any cause complicated by hypervolemia and pulmonary edema
-
Immune complex–mediated vasculitides, including systemic lupus erythematosus (SLE), Henoch-Schönlein purpura, and cryoglobulinemia
-
Pauci-immune vasculitides, including granulomatosis with polyangiitis and microscopic polyangiitis
-
Infections, such as Legionnaire disease
-
Renal vein thrombosis with pulmonary embolism
Differential Diagnoses
Media Gallery
-
Light microscopy (trichrome stain) shows globally increased cellularity, numerous polymorphonuclear cells, cellular crescent (at left of photomicrograph) and fibrinoid necrosis (brick red staining at right of photomicrograph). These findings are characteristic of diffuse proliferative glomerulonephritis.
-
Diffuse proliferative glomerulonephritis (DPGN). Immunofluorescent microscopy shows (except for anti–glomerular basement membrane [GBM] disease) a granular deposition of immunoglobulins, complement, and fibrin along the GBM, tubular basement membranes, and peritubular capillaries (image 2a). Linear deposition occurs in the GBM in anti-GBM disease (image 2b).
-
Diffuse proliferative glomerulonephritis (DPGN). Using electron microscopy, electron-dense deposits are visible in the mesangial, subendothelial, intramembranous, and subepithelial locations.
of
3
