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Anti-glomerular basement membrane disease — ABIM Board MCQ

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HardNephrologyAnti-glomerular basement membrane diseaseABIM Board

A 47-year-old man has hemoptysis, diffuse alveolar hemorrhage, rapidly rising creatinine, red-cell casts, and circulating anti-GBM antibodies. He is not dialysis dependent and kidney ultrasound excludes chronic atrophy. What treatment should begin now?

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Correct answer: D — Use plasma exchange with cyclophosphamide and glucocorticoids as induction

The best answer is “Use plasma exchange with cyclophosphamide and glucocorticoids as induction”. Pulmonary hemorrhage with active anti-GBM glomerulonephritis requires urgent combined therapy: plasma exchange removes pathogenic antibody, cyclophosphamide suppresses new production, and glucocorticoids control inflammation. Treatment begins on strong suspicion and should not await delayed reconfirmation. Routine long-term maintenance is unnecessary once antibodies clear because relapse is uncommon unless another disease, such as ANCA vasculitis, coexists.

Reference: KDIGO 2021 Clinical Practice Guideline for Glomerular Diseases: https://kdigo.org/wp-content/uploads/2017/02/KDIGO-Glomerular-Diseases-Guideline-2021-English.pdf