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Hyperchloremic metabolic acidosis — ABIM Board MCQ

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HardNephrologyHyperchloremic metabolic acidosisABIM Board

A 63-year-old has hemoptysis, rapidly rising creatinine, red-cell casts, cavitary pulmonary nodules, and PR3-ANCA positivity. Which induction approach is appropriate for this severe granulomatosis with polyangiitis presentation?

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Correct answer: A — Use rituximab with glucocorticoid-based remission-induction therapy

This is active severe ANCA-associated vasculitis with pulmonary and glomerular involvement. Remission induction uses rituximab or cyclophosphamide with glucocorticoids; methotrexate is not adequate for organ-threatening disease.

Reference: American College of Rheumatology: ANCA-Associated Vasculitis Guideline: https://rheumatology.org/vasculitis-guideline