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Anti-GBM Recurrence and Transplant — ESENeph MCQ

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ModerateGlomerulonephritisAnti-GBM Recurrence and TransplantESENeph

A 40-year-old man with known Goodpasture disease (anti-GBM positive) completed treatment 2 years ago. His anti-GBM antibodies have been negative for 18 months. His eGFR recovered to 35 mL/min/1.73m2. He asks about recurrence risk. What should he be told?

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Correct answer: E — Recurrence is very rare once anti-GBM antibodies are cleared; kidney transplant can be considered after antibodies are negative for at least 6-12 months

Anti-GBM disease has a very low recurrence rate once antibodies are cleared. KDIGO 2021 states that kidney transplantation can be considered when anti-GBM antibodies have been undetectable for at least 6 months (some centres recommend 12 months). Unlike ANCA vasculitis, late relapse is extremely uncommon. If the patient has double-positive disease (anti-GBM + ANCA), the ANCA component may relapse independently.

Reference: KDIGO 2021 – Glomerular Disease Guideline; Levy et al 2001 – Anti-GBM Long-Term Outcomes