Immune Aspects of the Glomerulonephritis Associated with Pulmonary Hemmorhage

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Abstract
Two cases of recurrent pulmonary hemorrhage with glomerulonephritis (Goodpasture''s syndrome) are presented with studies designed to explore a possible immune mechanism. A hypersensitivity reaction was suggested by light and electron microscopy which showed increased capillary permeability in the glomeruli and lungs and a necrotizing glomerulonephritis. Sections of the patient''s kidneys and lungs were examined for fluorescence after being stained with three fluorescein isocyanate labeled anti-sera: anti-human gamma globulin, anti-human albumin, and anti-group A Streptococcus. Gamma globulin was present in the glomerular capillary basement membranes, but not in the lungs. Circulating streptococcal antibodies could not be conclusively demonstrated in the sera. These studies suggest that the glomerulonephritis in Goodpasture''s syndrome represents an immune reaction unrelated to streptococcal infection. A possible mechanism is suggested: An unknown antigen becomes localized in the glomerular basement membrane causing formation of tissue antibodies. An anaphylactoid response occurs when more circulating antigen reacts with these antibodies. Lung tissue in itself, or altered by some other agent, may be the antigen.