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ANCA-associated vasculitis — SCE Rheumatology MCQ

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HardVasculitisANCA-associated vasculitisSCE Rheumatology

A patient has new MPO-ANCA glomerulonephritis with creatinine 356 micromol/L rising rapidly, no pulmonary haemorrhage and no anti-GBM antibodies. Rituximab-based induction is starting. What adjunct should be discussed?

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Correct answer: C — Consider adjunctive plasma exchange after individual benefit–harm assessment

Explanation lettering: C = shown as B · D = shown as C · B = shown as D

D is correct. BSR 2025 advises considering adjunctive plasma exchange in active GPA or MPA when creatinine is above 300 micromol/L, after individual assessment of adverse-event risk. The threshold does not mandate dialysis, anticoagulation or IVIG. Intravenous methylprednisolone is not universally required and does not replace induction immunosuppression.

Reference: 2025 British Society for Rheumatology ANCA-associated vasculitis recommendations. https://academic.oup.com/rheumatology/article/64/8/4470/8160140