A 26-year-old man presents with hemoptysis, rapidly rising creatinine, and a urine examination showing hematuria with dysmorphic red cells. Chest imaging shows bilateral alveolar infiltrates. Kidney biopsy demonstrates crescent formation in most glomeruli with linear IgG staining along the GBM. Along with high dose corticosteroids and cyclophosphamide, which intervention is specifically required in this condition?
- A Intravenous immunoglobulin
- B Plasma exchange ✓
- C Rituximab
- D Eculizumab
Correct answer: B. Plasma exchange
Explanation
Anti-GBM antibody mediated disease (Goodpasture syndrome) requires prompt plasma exchange combined with corticosteroids and cyclophosphamide, because plasmapheresis physically removes circulating anti-GBM antibodies and improves both renal and pulmonary outcomes. Immunosuppression alone cannot lower the antibody burden quickly enough to prevent irreversible crescentic injury. Rituximab targets CD20 A cells and is used in ANCA vasculitis, while eculizumab blocks terminal complement and plays no established role here.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.