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EGPA Renal Involvement — ESENeph MCQ

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HardRenal VasculitisEGPA Renal InvolvementESENeph

A 38-year-old man with eosinophilic granulomatosis with polyangiitis (EGPA, formerly Churg-Strauss syndrome) develops proteinuria and declining eGFR. He has asthma, blood eosinophilia (8 x 10^9/L), and MPO-ANCA is weakly positive. Biopsy shows pauci-immune crescentic GN. How should he be treated?

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Correct answer: E — As per KDIGO 2024 ANCA-associated vasculitis guideline

EGPA with renal involvement (crescentic GN) should be managed according to KDIGO 2024 AAV guideline recommendations, the same as GPA and MPA. Induction with glucocorticoids plus Rituximab or Cyclophosphamide is recommended. Mepolizumab (anti-IL-5) is effective for eosinophilic manifestations and relapse prevention but is insufficient as sole therapy for organ-threatening renal disease. It may be useful as maintenance or steroid-sparing therapy.

Reference: https://guidelines.ukkidney.org