Jeeja Jaya JANARDHANAN, Namesh KAMAT, Thotanolla Surya PRAKASH, Ram RAPUR
Turkish Journal of Nephrology - 2026;35(4):292-303
Background: Anti-glomerular basement membrane (anti-GBM) disease is a rare, life-threatening cause of rapidly progressive glomerulonephritis, often presenting with pulmonary kidney syndrome and frequently progressing to end-stage kidney disease (ESKD) if diagnosis and treatment are delayed. Methods: The authors conducted a retrospective observational study including all patients >= 10 years with serological and/or biopsy-proven anti-GBM disease treated at a tertiary care center in South India between January 2016 and January 2025. Demographic, clinical, serological, histopathological, and treatment data were collected, and predictors of dialysis independence, ESKD, and mortality were analyzed. Results: Thirty-two patients were identified; mean age was 39.8 years, and 53% were male. At presentation, 81.3% required dialysis, mean serum creatinine was 9.15 mg/dL, and 25% had pulmonary hemorrhage; anti-neutrophil cytoplasmic antibody co-positivity was seen in 34.4%. All patients received plasma exchange plus corticosteroids and cyclophosphamide. At the last follow-up, 25% recovered kidney function, 62.5% were dialysis dependent, and 12.5% had died. Multivariable logistic regression analysis demonstrated that dialysis requirement at presentation and interstitial fibrosis on kidney biopsy were independent predictors of failure to achieve kidney recovery, while older age and pulmonary involvement predicted mortality. Conclusions: In this single-center Indian cohort, anti-GBM disease was characterized by delayed presentation with advanced kidney failure, leading to low kidney recovery and high ESKD burden despite standard therapy. Early recognition, rapid referral, and timely initiation of plasma exchange-based immunosuppression are crucial to improve outcomes in resource-limited settings.
