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Anti-GBM Disease — ESENeph MCQ

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ModerateGlomerulonephritisAnti-GBM DiseaseESENeph

A 32-year-old woman with known anti-GBM disease presents with haemoptysis, haematuria, and creatinine of 680 umol/L. Anti-GBM antibodies are strongly positive. ANCA is negative. What is the recommended induction treatment?

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Correct answer: E — Plasma exchange plus Cyclophosphamide plus Glucocorticoids

KDIGO 2021 GN guideline recommends plasma exchange plus cyclophosphamide plus glucocorticoids as the standard induction regimen for anti-GBM disease. Plasma exchange removes pathogenic anti-GBM antibodies rapidly. Cyclophosphamide suppresses new antibody production. There is insufficient evidence for rituximab as first-line in anti-GBM disease. Treatment should be initiated immediately and should not be delayed for biopsy confirmation.

Reference: KDIGO 2021 – Clinical Practice Guideline for Glomerular Diseases