A 60-year-old woman presents with kidney failure. Diagnosis: anti-GBM disease. What critical test is needed to check for involvement beyond the kidneys?
A 60-year-old woman with hypertension and chronic kidney disease of unknown cause was referred to the emergency department because of a serum creatinine level of 7.8 mg per deciliter (reference range, 0.5 to 0.9). She had been feeling well before presentation. A urinalysis showed 2+ protein and more than 180 red cells per high-power field with no urinary casts. On the basis of a positive indirect fluorescent antibody assay for anti-glomerular basement membrane (GBM) antibodies and a kidney biopsy showing crescentic glomerulonephritis (left) with strong linear GBM staining for IgG on immunofluorescence (right), a diagnosis of anti-GBM glomerulonephritis was made. Which additional diagnostic test is required to look for extra-renal involvement?
What is the most likely diagnosis?
Acute Kidney Injury, Anti-GBM Disease, Chest imaging, Glomerulonephritis, Goodpasture’s Syndrome
