Goodpasture s syndrome

Glomerular diseases (e.g., anti-glomerular basement membrane disease, focal segmental glomerularsclerosis, IgA nephropathy, hemolytic uremic syndrome, systemic lupus erythematosus, Alport s syndrome, amyloidosis, membranous nephropathy, and Goodpasture s syndrome)... 

Goodpasture s syndrome A rare autoimmune disease that can affect the lungs and kidneys. 

Penicillamine onset may be seen in 1 to 3 months, and most responses occur within 6 months. Early adverse effects include skin rash, metallic taste, hypogeusia, stomatitis, anorexia, nausea, vomiting, and dyspepsia. Glomerulonephritis may occur, which manifests as proteinuria and hematuria. Penicillamine is usually reserved for patients who are resistant to other therapies because of the rare but potentially serious induction of autoimmune diseases (e.g., Goodpasture s syndrome, myasthenia gravis). 

Fatalities Penicillamine has been associated with fatalities due to aplastic anemia, agranulocytosis, thrombocytopenia, Goodpasture s syndrome, and myasthenia gravis. 

Hepatotoxicity Penicillamine has been associated with a mild elevation of hepatic enzymes that usually returns to normal even with continuation of the drug. Autoimmune syndromes Autoimmune syndromes that may be caused by penicillamine include polymyositis, diffuse alveolitis and dermatomyositis, Goodpasture s syndrome, myasthenic syndrome, pemphigus, and obliterative bronchiolitis. 

Advantage is taken of the properties of antimctabolitcs in chemotherapy. In cancer chemotherapy, several antimetabolites are used. These include methotrexate, 6-mercaptopunne, 6-thioguanine, 5-fluorouracil, and cystine arabinoside. In the chemotherapy of metastatic breast cancer, 5-fluorouracil and methotrexate, in combination with cyclophosphamide, have been used. Antimetabolites, sometimes along with corticosteroids, are used in the therapy of various autoimmune diseases, such as thrombocytenic purpura, thyroiditis, Goodpasture s syndrome, among others. 

Anemia may result from other complications even when iron supply is sufficient. A decrease in hemoglobin synthesis, a fault in transport mechanisms or destruction of erythrocytes have all been noted. Sideroblastic or iron-loading anemias are characterized by a fault in iron metabolism (see Section 62.2.3.2). There are also several other syndromes of iron deficiency known clinically, including pica and Goodpasture s syndrome (an immune-related lung and kidney disease). The different categories of anemia have been discussed in detail by Prasad.48... 

Microwave heat-assisted enzyme-linked immunosorbent assay (ELISA) has been used for measuring anti-glomerular basement membrane (GBM) antibodies in kidney serum (Van Dorp et al., 1991) The presence of GBM antibodies is one of the characteristics of Goodpasture s syndrome. The application of microwave heating reduces the duration of incubation to assay circulating anti-GBM autoantibodies. 

Nakamura, A., T. Yuasa, A. Ujike, M. Ono, T. Nukiwa, J. V. Ravetch, and T. Takai. 2000. Fcgamma receptor IIB-deficient mice develop Goodpasture s syndrome upon immunization with type IV collagen a novel murine model for autoimmune glomerular basement membrane disease. J. Exp. Med. 191 899-906. 

A 20-year-old man had had Goodpasture s syndrome for 2.5 years, end-stage renal disease on chronic hemodialysis for 15 months, and hypertension controlled... 

Goodpasture s syndrome has been reported after exposure to toluene and other organic solvents (11,12,13). 

Beirne GJ. Goodpasture s syndrome and exposure to solvents. JAMA 1972 222(12) 1555. 

Robert R, Touchard G, Meurice JC, Pourrat O, Yver L. Severe Goodpasture s syndrome after glue sniffing. Nephrol Dial Transplant 1988 3(4) 483 1. 

Nathan AW, Toseland PA. Goodpasture s syndrome and trichloroethane intoxication. Br J Clin Pharmacol 1979 8(3) 284-6. 

Grave s disease (thyrotoxicosis) Hashimoto s thyroiditis Pernicious anaemia Addison s disease Diabetes Type 1 Goodpasture s syndrome Myasthenia gravis Multiple sclerosis ... 

Anaphylaxis, atopy, asthma. Mediated by IgE. Autoimmune haemolytic anaemia, Goodpasture s syndrome, thrombocytopaenia. Mediated by IgM or IgG and complement. 

Inhalant abuse can result in kidney stones, severe kidney damage, and acute kidney failure. Electrolyte imbalances can occur in the kidneys and individuals may have difficulties urinating. In severely affected patients, this results in mental confusion, muscle weakness, nausea, and vomiting. Goodpasture s syndrome and glomerulonephritis, a chronic form of kidney disease, may also occur. 

Scarred lung tissue, impaired breathing, chemical pneumonitis Goodpasture s syndrome Hand tremors Weight loss... 

Reactions such as aplastic anemia, Goodpasture s syndrome, or thrombotic thrombocytopenic purpura (Moschcowitz s syndrome) are rare but serious. 

Alveolar hemorrhage can occur with penicillamine, usually as part of a fife-threatening pulmonary-renal sjm-drome resembling Goodpasture s syndrome (59,60). 

Three case reports from Belgium and France have illustrated the fact that rarely proliferative crescent-forming extracapillary glomerulonephritis and renal insufficiency can also occur (236,237). AH three patients had taken penicillamine for systemic sclerosis. Antimyeloperoxidase antineutrophil cjdoplasm antibodies were found in aU three one patient also had alveolar hemorrhage (that is Goodpasture s syndrome). 

A 56-year-old woman with systemic sclerosis taking penicillamine 750 mg/day had homogeneous antinuclear antibodies and antibodies to native DNA. Her manifestations of vasculitis were glomerulonephritis with renal insufficiency, pulmonary hemorrhage, and bilateral hemothorax (that is similar to Goodpasture s syndrome). 

Early hypersensitivity reactions are usually transient, and although there is undoubtedly an increased risk, in patients with a history of previous adverse reactions to penicillamine (or gold), re-exposure may not be followed by a relapse (SEDA-10, 218). In the case of serious complications, such as agranulocytosis, profound thrombocytopenia, polymyositis, or Goodpasture s syndrome, the repeated use of penicillamine carries unacceptable risks. Commencing penicillamine in patients with Wilson s disease can aggravate or even precipitate neurological involvement. 

Sternlieb I, Bennet B, Scheinberg lEI. D-penicillamine induced Goodpasture s syndrome in Wilson s disease. Ann Intern Med 1975 82 673. 

Gavaghan TE, McNaught PJ, Ralston M, Elayes JM. Penicillamine-induced Goodpasture s syndrome successful treatment of a fulminant case. Aust NZ J Med 1981 11 261-265. 

Peces R, Rivera JR, Arboleya LR, Lopez-Larrea C, Alvarez J. Goodpasture s syndrome in a patient receiving penicillamine and carbimazole. Nephron 1985 45 316-320. 

Sprecace [5] was the first to suggest an association between gasoline exposure and the pulmonary renal presentation of "idiopafhic pulmonary hemosiderosis", more commonly known as Goodpasture s syndrome. Following this observation several cross-sectional [6, 7-14] and case-control [15-29] studies investigating the relation between renal impairment and occupational hydrocarbon exposure have been published. 

Klavis G, Drommer W. Goodpasture s syndrome and the effects of benzene. Arch Toxicol 1970 26 40-55. 

On admission the first clinical presentation consists mainly of edema, which is of sudden onset and localized to the cervico-fadal region [33]. Dyspnoea, tachypnoea and asphyxia with chest pain following acute PPD poisoning have been reported in a number of studies [6] [12] [28]. PPD was proved to be the cause of asthmatic attacks in the sensitive individuals [46]. A case of Goodpasture s syndrome was reported to be induced by exposure to PPD [47]. Extrinsic allergic alveolitis also has been reported [48]. 

Bernis P, Homles J, Quoidbach A, Mahier PH, Bouvy P. Remission of Goodpasture s Syndrome after withdrawal of an unusual toxic. Clinical Nephrol 1985 23 312-317. 

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