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IgA Nephropathy — ESENeph MCQ

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HardGlomerulonephritisIgA NephropathyESENeph

A patient with new PR3-ANCA vasculitis has pulmonary haemorrhage with hypoxaemia and serum creatinine 335 micromol/L, rising from 120 micromol/L in ten days. Glucocorticoid and rituximab induction has started. Which adjunct should be considered?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Consider adjunctive plasma exchange because both KDIGO high-risk features are present

Explanation lettering: D = shown as B · B = shown as C · E = shown as D · C = shown as E

A is correct. KDIGO 2024 advises considering plasma exchange in ANCA-associated vasculitis when serum creatinine is above 300 micromol/L, when dialysis is required or creatinine is rapidly rising, and in diffuse alveolar haemorrhage with hypoxaemia. This patient meets both renal and pulmonary high-risk features. Plasma exchange is an adjunct to, not a replacement for, effective induction immunosuppression. It is not routine relapse prophylaxis, and the decision still weighs infection and bleeding risks, diagnostic certainty and the likely reversibility of kidney injury.

Reference: KDIGO 2024 ANCA-associated vasculitis guideline: https://kdigo.org/wp-content/uploads/2024/02/KDIGO-2024-ANCA-Vasculitis-Guideline.pdf