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Granulomatosis with polyangiitis — RCPSC IM MCQ

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HardNephrologyGranulomatosis with polyangiitisRCPSC IM

A patient with PR3-ANCA pulmonary-renal syndrome has falling hemoglobin, worsening hypoxemia and rapidly rising creatinine. What is the best induction approach?

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Correct answer: C — Start glucocorticoid plus rituximab or cyclophosphamide

The best answer is “Start glucocorticoid plus rituximab or cyclophosphamide”. Organ-threatening ANCA-associated vasculitis requires prompt remission induction with glucocorticoid plus rituximab or cyclophosphamide while infection and biopsy issues are addressed. Delay can result in irreversible kidney and lung injury. Plasma exchange is not routine for every case but may be considered in selected severe pulmonary hemorrhage or overlapping anti-GBM disease.

Reference: KDIGO, 2024 CKD guideline: https://kdigo.org/guidelines/ckd-evaluation-and-management/