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ANCA-associated vasculitis — SCE Acute Medicine MCQ

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HardAcute Rheumatological EmergenciesANCA-associated vasculitisSCE Acute Medicine

A patient has haemoptysis, rapidly rising creatinine, red-cell casts, cavitating lung nodules and PR3-ANCA positivity. Infection investigations have been obtained. What is the treatment priority?

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Correct answer: E — Start urgent remission induction for organ-threatening GPA

The best answer is “Start urgent remission induction for organ-threatening GPA”. This is correct because pulmonary haemorrhage and rapidly progressive glomerulonephritis threaten life and organ function. High-dose glucocorticoid with rituximab or cyclophosphamide is selected with renal–respiratory specialists while infection is addressed. Methotrexate is inadequate here, and plasma exchange is reserved for selected indications rather than automatic ANCA positivity.

Reference: UK Kidney Association acute kidney injury and rapidly progressive renal-disease guidance: https://www.nice.org.uk/guidance/ng148/chapter/Recommendations