Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive constitutional symptoms (fatigue, weight loss, fever) accompanied by rapidly progressive glomerulonephritis (RPGN) symptoms, including hematuria, proteinuria, and declining eGFR. Pulmonary involvement noted with symptoms of dyspnea, cough, or hemoptysis. No history of upper airway involvement (sinusitis/otitis) or granulomatous disease.
Clinical Examination Findings
General appearance: ill-appearing, pale, cachectic. Vitals: hypertension, tachycardia, low-grade pyrexia. Skin: palpable purpura, petechiae, or livedo reticularis on lower extremities. Lymph nodes: no significant lymphadenopathy.
Treatment Protocol
Induction therapy initiated with high-dose intravenous corticosteroids (methylprednisolone pulse) followed by oral prednisone taper. Concurrent immunosuppression with cyclophosphamide or rituximab. Renal protection via ACE inhibitors/ARBs if indicated. Prophylaxis for Pneumocystis jirovecii (PJP) with TMP-SMX.