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PLD Compromising PD ADPKD — ESENeph MCQ

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HardPeritoneal DialysisPLD Compromising PD ADPKDESENeph

A patient with microscopic polyangiitis in remission develops isolated palpable purpura. Creatinine, urinalysis and pulmonary assessment are unchanged, and MPO-ANCA titre is stable. What is the best next step?

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Correct answer: EEvaluate alternative causes and systemic activity before changing immunosuppression

The best answer is “Evaluate alternative causes and systemic activity before changing immunosuppression”. KDIGO treatment decisions are clinical. Drug exposure, infection, cryoglobulins, complement and evidence of kidney, pulmonary or other organ activity should be assessed before exposing the patient to intensified immunosuppression. “Treat renal vasculitis after confirming active glomerular inflammation” is less appropriate because cutaneous small-vessel inflammation is not specific and organ activity has not been demonstrated “Increase surveillance after persistent MPO-ANCA without clinical relapse” is less appropriate because serology alone does not define active relapse “Assess the skin lesion before attributing it to vasculitis” is less appropriate because infection, medicine reactions, cryoglobulinaemia and systemic vasculitis require assessment “Continue maintenance treatment while investigating the new rash” is less appropriate because this risks relapse and does not establish the cause

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