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AAV Induction Rituximab Avacopan KDIGO 2024 — ESENeph MCQ

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HardRenal VasculitisAAV Induction Rituximab Avacopan KDIGO 2024ESENeph

A patient has new MPO-ANCA crescentic glomerulonephritis, creatinine 580 micromol/L and pulmonary infiltrates without diffuse alveolar haemorrhage. Which statement best reflects induction planning?

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Correct answer: B — Rituximab or cyclophosphamide with steroid-sparing induction

Organ-threatening ANCA-associated vasculitis requires rituximab or cyclophosphamide with glucocorticoid-based induction. Avacopan is a glucocorticoid-sparing component, not an interchangeable stand-alone alternative to the induction agent. Plasma exchange is considered selectively after weighing dialysis dependence, rapidly rising creatinine and pulmonary haemorrhage; a single creatinine threshold does not make it mandatory. The competing options do not fit the renal phenotype, temporal relationship, treatment threshold or safety constraint described. Management still requires confirmation of current medicines, renal trajectory and relevant contraindications, followed by timely biochemical and clinical reassessment. Escalate urgently if life-threatening electrolyte disturbance, respiratory compromise, shock, neurological deterioration or a dialysis indication develops.

Reference: KDIGO 2021 Glomerular Diseases Guideline. https://kdigo.org/guidelines/gd/