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Anti-GBM Disease — RACP Adult Medicine MCQ

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HardMedical OncologyAnti-GBM DiseaseRACP Adult Medicine

A 55-year-old man presents with rapidly progressive renal failure, pulmonary haemorrhage, and a positive anti-GBM (anti-glomerular basement membrane) antibody. His creatinine is 800 µmol/L and he is anuric. Renal biopsy shows linear IgG on immunofluorescence with >80% crescents. What is the most important acute treatment?

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Correct answer: A — Plasma exchange plus cyclophosphamide plus corticosteroids

Anti-GBM disease (Goodpasture disease) with pulmonary haemorrhage requires urgent plasma exchange (to remove pathogenic anti-GBM antibodies) combined with cyclophosphamide and corticosteroids. Plasma exchange should be performed daily for 14 days or until anti-GBM antibodies are undetectable. Renal recovery is unlikely with >80% crescents and anuria, but treatment is still indicated to control pulmonary haemorrhage. Long-term dialysis may be required.

Reference: eTG – 2025 – Nephrology; KDIGO – 2024 – Anti-GBM Disease Guidelines