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IgM Cryoglobulinaemia Waldenstrom — ESENeph MCQ

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HardGlomerulonephritisIgM Cryoglobulinaemia WaldenstromESENeph

A patient with PR3-ANCA vasculitis in clinical remission has a rising ANCA titre but stable creatinine, bland urine and no systemic symptoms. What should guide management?

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Correct answer: D — Assess clinical organ activity before changing immunosuppression

The best answer is “Assess clinical organ activity before changing immunosuppression”. KDIGO bases relapse treatment on clinical evidence of renewed organ activity; an isolated ANCA rise can prompt closer assessment but does not itself establish relapse. “Escalate immunosuppression from the ANCA rise alone” exposes the patient to toxicity without demonstrated disease activity. “Start plasma exchange before assessing renal disease activity” is unsupported in this stable presentation. “Stop maintenance treatment after confirming the titre rise” is not implied by a rising biomarker. “Diagnose renal relapse from the rising titre and stable urine” substitutes serology for renal clinical evidence.

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