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Rapidly progressive glomerulonephritis — SCE Acute Medicine MCQ

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ModerateAcute Renal and Metabolic EmergenciesRapidly progressive glomerulonephritisSCE Acute Medicine

A 53-year-old man is assessed on the acute medical unit. He has haematuria, proteinuria and creatinine rising over 2 weeks. He has purpura and positive ANCA serology. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate investigation?

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Correct answer: E — Urgent renal biopsy after nephrology discussion

Urgent renal biopsy after nephrology discussion is the best answer because rapidly progressive nephritic syndrome requires urgent nephrology-led biopsy to guide immunosuppression. CT abdomen and pelvis with contrast is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Do not delay treatment planning when renal function is deteriorating rapidly.

Reference: KDIGO glomerular disease guideline