A 65-year-old woman presents with rapidly progressive glomerulonephritis, hemoptysis, and pANCA (MPO-ANCA) positivity. Renal biopsy shows pauci-immune crescentic glomerulonephritis. Which regimen is currently recommended as induction therapy?
- A High-dose prednisolone plus cyclophosphamide (oral or IV)
- B High-dose prednisolone plus rituximab ✓
- C Plasma exchange plus immunosuppression in all patients
- D Mycophenolate mofetil plus prednisolone
Explanation
For ANCA-associated vasculitis (AAV) with severe renal involvement, both rituximab and cyclophosphamide combined with glucocorticoids are Class I first-line induction options per EULAR/ACR 2022 guidelines; rituximab is increasingly preferred due to non-inferior efficacy and better safety profile (RAVE trial). The PEXIVAS trial (2020) showed that plasma exchange does not reduce mortality or ESRD in AAV, so it is no longer routinely recommended for all patients — only considered in selected cases (severe respiratory hemorrhage). Mycophenolate is used for remission maintenance, not severe induction.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.