NDT Advance Access originally published online on October 18, 2005
Nephrology Dialysis Transplantation 2006 21(2):397-401; doi:10.1093/ndt/gfi230
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© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Original Articles: Clinical Nephrology
Anti-glomerular basement membrane antibodies in the diagnosis of Goodpasture syndrome: a comparison of different assays
1 Unità Operativa di Immunologia Clinica, Dipartimento Area Medica e Dipartimento di Nefrologia e Immunologia, Azienda Ospedaliera Ospedale San Carlo Borromeo and 2 Fondazione D’Amico per la Ricerca in Nefrologia, Milano, Italy
Correspondence and offprint requests to: Dr R. A. Sinico, Unità Operativa di Immunologia Clinica, Azienda Ospedaliera Ospedale San Carlo Borromeo, Via Pio Secondo, 3, 20153 Milano, Italy. Email: renatoalberto.sinico{at}fastwebnet.it
Background. The role of anti-glomerular basement membrane (GBM) antibodies in the pathogenesis of Goodpasture syndrome (GPS) is firmly established. Untreated, the disease may follow a fulminating course. Early identification of patients has important implications in terms of management and prognosis. Therefore, a diagnostic test for the determination of circulating anti-GBM antibodies, of very high sensitivity and specificity, is necessary. A number of assays, using different antigenic substrates, are available, but studies comparing the ‘performances’ of the different tests are scarce.
Methods. The aim of our work was to evaluate the sensitivity and specificity of four immunoassay-based anti-GBM antibodies kits. Thirty-four serum samples from 19 GPS patients, 41 pathological and 28 normal controls were studied retrospectively (the follow-up samples were not included in the analysis of performance data). Cut-off limits were derived from receiver operating characteristics curve analysis.
Results. All the assays showed a comparable good sensitivity (between 94.7 and 100.0%), whereas specificity varied considerably (from 90.9 to 100.0%). The better performance in terms of sensitivity/specificity was achieved by a fluorescence immunoassay which utilizes a recombinant antigen.
Conclusion. All the assays have a good performance, with high sensitivity; however, the specificity may vary considerably.
Keywords: anti-glomerular basement membrane (GBM) antibodies; anti-GBM disease; ELISA; Goodpasture syndrome; NC1 portion of the 
3 chain of type IV collagen
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