A 35-year-old man presents with hemoptysis, hematuria, and rapidly progressive glomerulonephritis. Serum creatinine is 5.6 mg/dL. Anti-GBM antibody is positive. Kidney biopsy shows linear IgG deposits along GBM with crescents. What is the most appropriate initial treatment?

• A Rituximab + mycophenolate mofetil
• B IV methylprednisolone pulses alone
• C Hemodialysis only; immunosuppression is futile at this creatinine level
• D Methylprednisolone 500 mg IV pulse + cyclophosphamide + plasmapheresis ✓

Explanation

Goodpasture's syndrome (anti-GBM disease) requires aggressive triple therapy: high-dose corticosteroids (IV methylprednisolone) + cyclophosphamide (to suppress antibody production) + daily plasmapheresis for 14 days (to remove circulating anti-GBM antibodies). Plasmapheresis is critical and reduces mortality. Rituximab is used in refractory cases. Immunosuppression remains indicated even with significant renal impairment if the patient is not dialysis-dependent at presentation; outcomes are worse if creatinine >6 mg/dL at diagnosis but treatment is still attempted.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.