Treatment of Goodpasture Syndrome in Glomerulonephritis with Positive Anti-GBM and Positive Antineutrophil Cytoplasmic Antibodies (ANCA)

Clinical Scenario

Double-Positive: Anti-GBM & ANCA

This protocol applies to patients with glomerulonephritis who are seropositive for both anti-glomerular basement membrane (anti-GBM) antibodies and antineutrophil cytoplasmic antibodies (ANCA). This double-positive serological pattern identifies a distinct clinical subgroup whose prognosis and long-term management differ meaningfully from anti-GBM disease alone.

Approach Overview

This double-positive subgroup warrants aggressive early intervention — including plasma exchange alongside immunosuppressive therapy — followed by longer-term maintenance guided by vasculitis management principles. The complete regimen, sequencing, and duration are available in the full protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1038/kisup.2012.27

Patients with GN who are anti-GBM- and ANCA-positive should be treated with maintenance therapy as for patients with AAV.
In contrast to patients with only anti-GBM antibodies, double-positive patients have a similar relapse rate as that of patients with AAV and require aggressive early treatment as for anti-GBM disease followed by maintenance immunosuppression as for AAV (Chapter 9).

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