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ANCA-associated glomerulonephritis investigation — SCE Rheumatology MCQ

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HardMusculoskeletal investigationsANCA-associated glomerulonephritis investigationSCE Rheumatology

A 44-year-old man has recurrent sinusitis, haematuria and pulmonary nodules. PR3-ANCA is positive by immunoassay, urine microscopy shows red cell casts and creatinine is rising. What is the most appropriate next step?

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Correct answer: D — Urgent renal assessment with biopsy where feasible before induction therapy

ANCA supports the diagnosis, but organ-threatening disease requires urgent renal assessment, often biopsy, and rapid induction treatment. ANCA positivity alone is not enough; the urine and renal decline show active glomerulonephritis. Delaying referral risks irreversible renal damage.

Reference: BSR ANCA-associated vasculitis recommendations 2025; EULAR AAV recommendations