Figure 1732

Without treatment, circulating anti-glomerular basement membrane autoantibodies become undetectable within 6 to 18 months of disease onset [40,41]. Treatment of the primary disease with plasma exchange, cyclophosphamide, and steroids leads to rapid loss of circulating antibodies. Patients who need transplantation while circulating antibodies are still detectable should be treated with plasma exchange before and after transplantation to minimize circulating antibody levels and with cyclophosphamide therapy for 2 months. A similar approach should be used in patients with clinical recurrence. Patients who have linear immunoglobulin deposition in the absence of focal necrosis, crescents, or renal dysfunction do not require treatment.

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