The figure shows routine histologic and immunofluorescence images of a kidney biopsy specimen taken from a 53-year-old man with acute-onset renal failure and hemoptysis (coughing up blood)
The histologic section is notable for glomerular inflammation in a crescentic distribution. Staining, using fluorescently tagged anti-IgG antibody, shows linear deposits of IgG along the glomerular basement membrane. Urinalysis is positive for moderate proteinuria and red cell casts. A chest radiograph shows pulmonary infiltrates. Which of the following is the most likely diagnosis?
A. Systemic lupus erythematosus
B. Graves' disease
C. Chronic allograft rejection
D. Goodpasture's syndrome
E. Poststreptococcal glomerulonephritis
ANS: D. Goodpasture's syndrome is a type II hypersensitivity disease in which IgG antibodies against the glomerular basement membrane (GBM) of the kidney deposit in a linear distribution, causing complement- and Fc receptor-mediated inflammation and subsequent nephritis. These anti-GBM antibodies cross-react with pulmonary alveolar basement membranes to produce the typical clinical scenario of pulmonary hemorrhages associated with renal failure. Note that the pathology here contrasts to that seen in glomerulonephritis caused by type III hypersensitivity diseases (e.g., systemic lupus erythematosus, poststreptococcal glomerulonephritis) in that deposits are linear and smooth (antibody) versus granular and coarse (antigen-antibody immune complex). Chronic allograft rejection more closely resembles a type IV hypersensitivity reaction. Graves' disease does not directly involve the kidney.
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