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ANCA-associated pulmonary renal vasculitis — SCE Acute Medicine MCQ

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HardAcute Rheumatological EmergenciesANCA-associated pulmonary renal vasculitisSCE Acute Medicine

A patient has haemoptysis, diffuse alveolar haemorrhage, rapidly rising creatinine, red-cell casts and strongly positive anti-GBM antibodies. What is the immediate treatment?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Begin plasma exchange and immunosuppression for anti-GBM disease

The best answer is “Begin plasma exchange and immunosuppression for anti-GBM disease”. This is correct because circulating pathogenic antibody is removed with plasma exchange while glucocorticoid and cyclophosphamide suppress ongoing production. Pulmonary haemorrhage makes the situation particularly urgent. Biopsy supports prognosis and diagnosis but must not create harmful delay when serology and phenotype are compelling.

Reference: UK Kidney Association acute kidney injury guidance: https://www.nice.org.uk/guidance/ng148/chapter/Recommendations