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Anti-GBM disease with pulmonary-renal syndrome — SCE Acute Medicine MCQ

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HardRenal medicineAnti-GBM disease with pulmonary-renal syndromeSCE Acute Medicine

A 55-year-old woman presents with malaise, haemoptysis and rapidly rising creatinine. Urinalysis shows blood 3+ and protein 2+; microscopy shows red-cell casts. Chest radiograph shows bilateral alveolar infiltrates and anti-GBM antibody returns positive. What is the most appropriate next step in management?

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Correct answer: E — Urgent nephrology referral for plasma exchange, immunosuppression and renal biopsy planning

Anti-GBM disease causes pulmonary-renal syndrome with rapidly progressive glomerulonephritis and alveolar haemorrhage, requiring urgent nephrology treatment including plasma exchange and immunosuppression. Pneumonia alone does not explain red-cell casts and rapidly progressive renal failure. Early treatment may preserve renal function and reduce pulmonary haemorrhage.

Reference: KDIGO glomerular diseases guideline; UK Kidney Association rapidly progressive glomerulonephritis guidance