Incidence and outcome of antiglomerular basement membrane disease in Chinese.
BACKGROUND
Antiglomerular basement membrane (anti-GBM) disease is an uncommon disease, especially among Asian population. Many reports and studies on this condition in the Caucasian population are available, but little information exists on anti-GBM disease in Asians. To study the incidence and clinical characteristics of anti-GBM disease among Chinese patients, we reviewed our experience of anti-GBM disease in our hospital (Queen Mary Hospital, Hong Kong) from 1992 to 2003.


METHODS
All patients who were admitted for acute renal impairment, which was caused by crescentic glomerulonephritis associated with linear immunoglobulin G (IgG) staining on immunofluorescence, were included in the analysis. Serum anti-GBM antibodies were detected by either enzyme-linked immunofluorescence or indirect immunofluorescence. Ten patients were treated for anti-GBM disease during this 11-year period, yielding an incidence of approximately 0.6 cases per million population per year.


RESULTS
In this cohort, anti-GBM disease predominantly affected older patients (mean age: 58.6 +/- 21.7 years). Eight patients were aged between 60 and 80 years and there was a female preponderance (M:F = 2:8). The 1-year renal and patient survival was 15% (95% CI 0-40%) and 70% (95% CI 42-98%), respectively. Most patients presented with non-specific symptoms as well as impaired renal function. Detection of anti-GBM antibody provided a good screening test for the disease. Antiglomerular basement membrane antibodies were not detected in two patients. All but two patients received steroid, cyclophosphamide and intensive plasmapheresis therapy. Haemoptysis occurred in four patients (40%), and usually lagged behind the renal presentation and commencement of treatment. Six patients required long-term dialysis after the acute disease. Three patients died from the disease, two died from pulmonary complications and one died suddenly after a partial recovery of renal function.


CONCLUSIONS
Antiglomerular basement membrane disease is uncommon among the Chinese population. It predominantly affects older patients, and prognosis is poor. Long-term preservation of renal function after the initial attack is unusual.
Li
Fu Keung
FK
Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong.
Tse
Kai Chung
KC
Lam
Man Fai
MF
Yip
Terence P S
TP
Lui
Sing Leung
SL
Chan
Gavin S W
GS
Chan
Kwok Wah
KW
Chan
Eric Y T
EY
Choy
Bo Ying
BY
Lo
Wai Kei
WK
Chan
Tak Mao
TM
Lai
Kar Neng
KN
D000293:Adolescent; D000328:Adult; D000368:Aged; D019867:Anti-Glomerular Basement Membrane Disease / Q000150:complications / Q000453:epidemiology* / Q000208:ethnology; D000906:Antibodies / Q000097:blood; D044466:Asian People; D001323:Autoantibodies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis
D000906:Antibodies; D001323:Autoantibodies; C051951:antiglomerular basement membrane antibody