Nephrology: anti-GBM disease: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

General Medicine · Nephrology: anti-GBM disease

Sample item

A 25-year-old smoker has haemoptysis and breathlessness, haematuria and a serum creatinine rising from 1.2 to 4.8 mg/dL over 10 days. Renal biopsy shows crescentic glomerulonephritis with linear IgG deposition along the glomerular basement membrane. What is the most appropriate initial treatment?

APlasma exchange with cyclophosphamide and corticosteroidsBSupportive care with an ACE inhibitorCRituximab aloneDOral prednisolone alone

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Plasma exchange with cyclophosphamide and corticosteroids

Anti-GBM (Goodpasture) disease results from antibodies against the alpha-3 chain of type IV collagen, causing pulmonary haemorrhage and rapidly progressive glomerulonephritis. Plasma exchange removes circulating pathogenic antibody, while cyclophosphamide and steroids stop new antibody production. Treatment must start urgently, before the patient becomes dialysis-dependent, and smoking cessation is advised.

Option by option

A. Plasma exchange with cyclophosphamide and corticosteroids (correct)
Correct. This triple regimen removes antibody and suppresses its production.
B. Supportive care with an ACE inhibitor
ACE inhibition is renoprotective in chronic proteinuric disease but does not treat a rapidly progressive immune process and may worsen acute kidney injury.
C. Rituximab alone
Rituximab alone is not established first-line therapy and does not clear existing circulating antibody.
D. Oral prednisolone alone
Steroids alone neither remove existing antibody nor prevent its synthesis adequately.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Plasma exchange with cyclophosphamide and corticosteroids. Anti-GBM (Goodpasture) disease results from antibodies against the alpha-3 chain of type IV collagen, causing pulmonary haemorrhage and rapidly progressive glomerulonephritis.

Why is "Supportive care with an ACE inhibitor" not the answer?

ACE inhibition is renoprotective in chronic proteinuric disease but does not treat a rapidly progressive immune process and may worsen acute kidney injury.

Why is "Rituximab alone" not the answer?

Rituximab alone is not established first-line therapy and does not clear existing circulating antibody.

Why is "Oral prednisolone alone" not the answer?

Steroids alone neither remove existing antibody nor prevent its synthesis adequately.

What concept does this question test?

It tests Nephrology: anti-GBM disease in General Medicine. Plasma exchange removes circulating pathogenic antibody, while cyclophosphamide and steroids stop new antibody production. Treatment must start urgently, before the patient becomes dialysis-dependent, and smoking cessation is advised.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Nephrology: anti-GBM disease?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.