A 55-year-old presents with malaise, haemoptysis and creatinine 420 (baseline 90). Urine dip: blood +++, protein ++. How will you proceed?

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This is a pulmonary-renal syndrome until proven otherwise. I'd assess A-E, send urgent ANCA, anti-GBM, ANA, complement, immunoglobulins, hepatitis B/C, HIV, urine ACR/PCR with microscopy looking for red-cell casts, and arrange HRCT chest. I'd refer to renal that day for biopsy planning and start protective measures — stop nephrotoxins, manage K+, plan dialysis access in case. If anti-GBM is positive I'd discuss urgent plasma exchange and pulsed methylprednisolone. For ANCA, I'd start induction with steroids and either rituximab or cyclophosphamide after a full infection screen including TB. Plasma exchange would be reserved for severe DAH or dialysis-dependent renal failure per PEXIVAS. I'd involve rheumatology and ITU and have an honest conversation with the patient about the seriousness, the immunosuppression risks, and likely renal trajectory.

Suspected rapidly progressive glomerulonephritis

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