Nephrology Dialysis Transplantation, Vol 12, Issue 9 1863-1868, Copyright © 1997 by Oxford University Press
K Westman, P Bygren, I Eilert, A Wiik and J Wieslander
Background. Pulmonary renal syndrome is encountered in
several diseases such as Goodpasture's syndrome, antineutrophil cytoplasmic
antibody (ANCA) associated systemic vasculitis, systemic lupus
erythematosus (SLE) and infection-associated or drug-induced
glomerulonephritis. To preserve organ function it is of vital importance to
make the correct diagnosis and institute adequate therapy early, in the
acute phase. Methods. An enzyme-linked immunosorbent
assay (ELISA), specially designed as a rapid screening assay for
antiglomerular basement membrane (anti-GBM) antibody proteinase-3 (PR3-)
ANCA and myeloperoxidase-(PMPO-) ANCA were evaluated from 1060 serum
samples drawn from patients with clinically suspected pulmonary renal
syndrome or rapidly progressive glomerulonephritis (RPGN).
Results. Of the 1060 serum samples, 142 were positive
for anti-GBM antibody (n=19), PR3-ANCA (n=60), or MPO-ANCA (n=73). Of the
142 samples, 10 were double positive. Reanalysis of positive sera with a
quantitative ELISA yielded results manifesting good correlation with those
of the rapid screening assay. Of 918 sera found to be negative in the rapid
screening assay, 105 were also tested with IIF, 11 being found to be
positive. However, these 11 sera manifested no specificity for PR3 or MPO,
but some were specific for bactericidal/permeability-increasing proteins,
lactoferrin or elastase ANCAs. Two of the patients whose sera yielded
negative results in the rapid assay had systemic vasculitis.
Conclusions. The ELISA thus detects the true
antibodies to PR3, MPO, and GBM, whereas IIF detects additional
specificities. The findings suggest the rapid assay results to be of high
positive predictive value, and the assay to be of high diagnostic
specificity and sensitivity and thus useful in the diagnostic workup in
suspected cases of RPGN or pulmonary renal syndrome.
Keywords: pulmonary renal syndrome; rapidly
progressive glomerulonephritis; ANCA; anti-GBM antibody
ORIGINAL ARTICLES
Rapid screening assay for anti-GBM antibody and ANCAs; an important tool for the differential diagnosis of pulmonary renal syndromes
Department of Nephrology, University Hospital, Lund, S-221 85 Lund, Sweden; Wieslab AB, Lund, Sweden; Department of Autoimmunity, Statens Seruminstitut, Copenhagen, Denmark; Corresponding author
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