Pregnancy GFR Adaptation — ESENeph MCQ
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Correct answer: D — Individualize maintenance duration using relapse and toxicity risk
The best answer is “Individualize maintenance duration using relapse and toxicity risk”. KDIGO frames duration as 18 months to 4 years and balances phenotype, prior relapse, organ threat, adverse effects, infection risk and patient preference. “Consider shorter maintenance when relapse risk is low and toxicity high” is less appropriate because pauci-immune vasculitis can relapse despite absent serology “Use at least 18 months while reassessing relapse and toxicity risk” is less appropriate because this is shorter than the KDIGO range “Consider longer maintenance when prior relapse predicts further recurrence” is less appropriate because KDIGO recommends individualization rather than universal lifelong exposure “Use clinical relapse risk alongside ANCA rather than ANCA alone” is less appropriate because serology cannot provide a stopping rule in ANCA-negative disease
Reference: KDIGO 2024 ANCA-associated vasculitis guideline: https://kdigo.org/wp-content/uploads/2024/02/KDIGO-2024-ANCA-Vasculitis-Guideline.pdf