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ANCA-associated vasculitis — ESENeph MCQ

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HardGlomerulonephritisANCA-associated vasculitisESENeph

A 42-year-old man presents with 3 weeks of malaise, weight loss and haemoptysis. Blood pressure is 158/92 mmHg and oxygen saturations are 93% on air. Creatinine has risen from 84 to 286 micromol/L in 4 weeks; urine dipstick shows blood 3+ and protein 2+. Urine microscopy shows dysmorphic red cells and red cell casts, and chest CT shows patchy alveolar haemorrhage. What is the most likely diagnosis?

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Correct answer: B — ANCA-associated crescentic glomerulonephritis

The pulmonary haemorrhage, rapidly rising creatinine and active urinary sediment point to rapidly progressive glomerulonephritis, most commonly ANCA-associated vasculitis in this age group. IgA nephropathy can cause macroscopic haematuria but does not usually cause alveolar haemorrhage. Membranous and minimal change disease are nephrotic syndromes rather than nephritic syndromes with red cell casts. The key pearl is that pulmonary-renal syndrome requires urgent serology, renal biopsy when safe, and immediate specialist immunosuppression.

Reference: KDIGO 2024 ANCA Vasculitis Guideline; Renal Medicine 2022 Curriculum