ANCA Titre Monitoring — ESENeph MCQ
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Correct answer: C — Closer clinical surveillance, not automatic treatment escalation in isolation
The best answer is “Closer clinical surveillance, not automatic treatment escalation in isolation”. KDIGO recognizes that persistent or rising ANCA can predict relapse, but treatment decisions should not be based on serology alone. “Immediate cyclophosphamide because serology alone proves relapse” is less appropriate because active disease requires clinical correlation “No further follow-up because ANCA has no prognostic information” is less appropriate because a rise can inform relapse risk and monitoring “Permanent withdrawal of maintenance treatment” is less appropriate because that may increase relapse risk and is not justified by the result “Consider kidney biopsy if urine abnormalities or kidney dysfunction develops” is less appropriate because biopsy is selected by clinical evidence rather than mandated by titre alone
Reference: KDIGO 2024 ANCA-associated vasculitis guideline: https://kdigo.org/wp-content/uploads/2024/02/KDIGO-2024-ANCA-Vasculitis-Guideline.pdf