The Tissue's the Issue

Zeidner et al examine the case of a 50-year-old woman with Goodpasture's syndrome. Goodpasture's syndrome was confirmed within hours of the patient's kidney biopsy. Treatment with plasmapheresis, intravenous corticosteroids, and oral cyclophosphamide, allowed her to be weaned to conventional ventilation within several days and to be extubated 8 days after starting plasmapheresis. As expected, based on the severity of disease at presentation (serum creatinine > 5.7 mg/dL, dialysis requirement at presentation, > 50% crescents), she remains dialysis-dependent with undetectable anti-GBM antibody 2 months after diagnosis. Although Wegener's granulomatosis was initially the leading clinical diagnosis, a rapid kidney biopsy secured the correct diagnosis, defined prognosis, and permitted appropriate, tailored therapy.