title: Goodpasture's syndrome with positive C-ANCA and normal renal function: a case report.
abstract: BACKGROUND
  Goodpasture's syndrome consists of a triad of pulmonary hemorrhage, rapidly progressive glomerulonephritis and anti-glomerular basement membrane (anti-GBM) antibodies, either in circulation or fixed to the kidney. The absence of renal manifestations is uncommon. We present a case of biopsy proven anti-GBM antibody disease with normal renal function, mild urinary abnormalities and positive C-antineutrophil cytoplasmic antibody (C-ANCA) serology.
  
  
  METHODS
  A 44-year-old female was treated for repeated episodes of hemoptysis and one episode of respiratory failure requiring ventilatory support. She had minor urinary abnormalities in the form of microscopic hematuria and non-nephrotic proteinuria. She also had positive C-ANCA. Her lung biopsy showed evidence of intra-alveolar hemorrhage with linear IgG deposits in the basement membrane of the alveolar capillaries. Owing to these lung biopsy findings, a kidney biopsy was carried out, which showed minimal thickening of the glomerular basement membrane and linear IgG and C3 deposits along the capillary walls. Her renal function remained persistently normal.
  
  
  CONCLUSIONS
  Goodpasture's syndrome is a rare disease. Even though the classical presentation is that of rapidly progressive glomerulonephritis pulmonary hemorrhage and anti-GBM antibodies in the circulation and kidneys, in rare cases it can present with repeated pulmonary hemorrhage and minor urinary abnormalities. In all cases of repeated pulmonary hemorrhage, the possibility of Goodpasture's syndrome should be considered and investigated further.
authors.affiliation: Department of Nephrology, RIPAS Hospital, Brunei Darussalam. ramsdr@yahoo.com
authors.forename: Arunachalam
authors.initials: A
authors.lastname: Ramaswami
authors.forename: Thiraviyam
authors.initials: T
authors.lastname: Kandaswamy
authors.forename: Tholappan
authors.initials: T
authors.lastname: Rajendran
authors.forename: Hla
authors.initials: H
authors.lastname: Aung
authors.forename: Chakko K
authors.initials: CK
authors.lastname: Jacob
authors.forename: Haji Shaukat
authors.initials: HS
authors.lastname: Zinna
authors.forename: Pemasiri Upali
authors.initials: PU
authors.lastname: Telesinge