ORIGINAL RESEARCH article
Front. Immunol.
Sec. Autoimmune and Autoinflammatory Disorders : Autoimmune Disorders
This article is part of the Research TopicOrgan-Specific Autoimmune and Rare Diseases: Quantitative Modeling Approaches in Support of the Biology, Disease Progression, Pharmacology, and Developments of TherapiesView all 5 articles
Bowman's capsule rupture and its clinical significance in patients with anti-glomerular basement membrane disease
Provisionally accepted
- Peking University First Hospital, Bejing, China
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Background: Anti-glomerular basement membrane (GBM) disease represents the most severe form of crescentic glomerulonephritis. Previous studies demonstrated that Bowman's capsule rupture contributed to the progression of crescentic glomerulonephritis. However, its role in anti-GBM disease remains unclear. The aim of this study was to investigate the prevalence and severity of Bowman's capsule rupture in patients with anti-GBM disease, and its clinical associations. Methods: A total of 72 patients diagnosed with biopsy-proven anti-GBM disease with complete clinical and pathologic data were retrospectively enrolled. Results: Extensive Bowman's capsule rupture occurred in 70 patients (97.2%) with an average median percentage of 52.8% of all glomeruli on each kidney biopsy. The percentage of Bowman's capsule rupture showed strong association with kidney injuries (incidence of oligoanuria, eGFR, and serum creatinine on diagnosis; P < 0.001), and the levels of anti-GBM antibody (P = 0.013). Histologically, Bowman's capsule rupture percentage was positively correlated with crescents formation (P = 0.001) and increased proportion of cellular-fibrous crescents specifically (P = 0.047). Kaplan– Meier analysis revealed significantly divergent outcome in kidney survival (P = 0.006) and kidney recovery (P = 0.016) when patients divided into different groups according to the percentage of Bowman's capsule rupture. The incorporation of Bowman's capsule rupture into two proposed prediction models of risk stratification tool and renal risk score could improve their prognostic performance. Conclusions: Bowman's capsule rupture serves as both a distinct histopathological feature and a critical determinant of kidney injury in anti-GBM disease. More importantly, as a simple, standalone parameter, it demonstrates robust predictive value for kidney outcomes in patients with anti-GBM disease.
Keywords: Anti-Glomerular Basement Membrane Disease, Crescentic glomerulonephritis, Bowman's capsule rupture, end-stage kidney disease, prognosis
Received: 27 Jun 2025; Accepted: 20 Nov 2025.
Copyright: © 2025 Kuang, Lin, Yu, Cui, Zhao and Jia. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Huang Kuang, kuanghuang@bjmu.edu.cn
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