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Anti-GBM pulmonary-renal syndrome — SCE Respiratory MCQ

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HardInterstitial Lung DiseaseAnti-GBM pulmonary-renal syndromeSCE Respiratory

A 32-year-old woman with diffuse alveolar haemorrhage has haemoptysis, anaemia and new bilateral ground-glass opacities. Urinalysis shows blood and protein. Anti-GBM antibody is positive. What is the most appropriate management?

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Correct answer: D — Urgent plasma exchange, immunosuppression and renal-respiratory specialist care

The best answer is “Urgent plasma exchange, immunosuppression and renal-respiratory specialist care”. Urgent plasma exchange, immunosuppression and renal-respiratory specialist care is the recommended next management step after the clinical severity, prior treatment and contraindications in the stem are taken into account. The alternatives are either insufficient, unnecessarily invasive, or reserved for a different physiological or risk profile. The remaining choices—“Inhaled corticosteroid alone, after safety review, after safety review”, “Watchful waiting with repeat CT in 3 months, after specialist assessment”, “Long-term macrolide prophylaxis, with clinical reassessment, with clinical reassessment”, “Talc pleurodesis, within a respiratory pathway, within a respiratory pathway”—are credible in related respiratory presentations, but each addresses a different diagnostic, staging or management decision and does not fit the decisive findings and pathway position in this stem.

Reference: KDIGO 2021 glomerular diseases guideline: https://kdigo.org/wp-content/uploads/2021/10/KDIGO-2021-Guideline-for-the-Management-of-Glomerular-Diseases.pdf