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During the congress, E-Posters will be accessible to all participants on the congress website 24/7, as well as in the E-poster stations in the congress center.
Preparing your E-Poster
Please review the E-Poster format requirements carefully when preparing your E-Poster. Should your E-Poster not meet the mentioned requirements, it may not be displayed as described above.
E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
Please follow the instructions below to input your abstract title.
Abstract titles should be brief and reflect the content of the abstract.
Kidney biopsy is the gold standard for diagnosing anti–glomerular basement membrane (anti-GBM) disease, yet urgent therapy may be required when biopsy is not feasible or would delay care. In real-world practice, biopsy can be precluded by high bleeding risk, patient refusal, solitary kidney, or recent ischemic/thrombotic events where interrupting antiplatelets/anticoagulation is unsafe. Modern immunoassays detect circulating anti-GBM antibodies with high accuracy, raising whether biopsy is always required to initiate treatment. We present a case series of suspected anti-GBM disease treated with and without biopsy, highlighting when a serology-driven approach is reasonable in practice.
We retrospectively analyzed 7 adult patients with serology positive for anti-GBM antibody treated from January 1, 2023, to August 31, 2025 at two tertiary centers. We include all adult age >18 years, compatible clinical presentation (acute or subacute nephritic syndrome, rapid rise in serum creatinine, and/or pulmonary hemorrhage), positive anti-GBM antibody serology by ELISA (with or without MPO/PR3-ANCA), minimum follow up of three months and an intent to initiate treatment immediately. Exclusion criteria included patients with atypical presentations (i.e., negative serology), age <18 years, missing key clinical data or lost to follow up. Primary outcomes were dialysis dependence at discharge and ≈8 weeks and creatinine trajectory; pragmatic biomarkers were urine-output trajectory, dialysis status, and anti-GBM titer kinetics.
Seven patients were included (4 men, 3 women; age range, 43–81 years). Biopsy was performed in 3 patients (2 classic anti-GBM; 1 nodular diabetic glomerulosclerosis with low-positive anti-GBM, averting PLEX and cytotoxic therapy) and deferred in 4 patients (due to refusal or high bleeding risk). All biopsy-deferred patients received same-day serology-guided induction (PLEX plus high-dose glucocorticoids, with eGFR-adjusted cyclophosphamide unless contraindicated or rituximab used). Early improvement in urine output tracked with dialysis independence (4/4 with early UO rise), whereas anuria or dialysis at presentation predicted non-recovery despite antibody clearance (1/1). At early follow-up (~8 weeks), five survivors were dialysis-independent, one remained dialysis-dependent, and one patient died after a catastrophic biopsy-related hemorrhage complicated by infection.
In this case series, serology-driven treatment in suspected anti-GBM disease based on typical clinical features and positive serology without kidney biopsy, appeared feasible, safe, and effective in selected patients, while avoiding biopsy-related harm. These findings support individualized biopsy decisions and warrant prospective evaluation.
