This handout is for microscopic polyangiitis (mpa). Your care team identified this based on: positive mpo-anca + rising creatinine / active urine sediment.
Other reasons your team may use this plan: pulmonary-renal syndrome — hemoptysis / hypoxia + rpgn; dysmorphic rbcs / rbc casts + rising cr (pauci-immune rpgn); fever / weight loss + palpable purpura + mononeuritis multiplex.
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| renal biopsy | — | procedure | — | 2021 ACR/VF — pauci-immune necrotizing crescentic GN; distinguish from anti-GBM linear IgG and immune-complex GN; % normal glomeruli prognosticates renal recovery |
| plasma exchange (selective) | — | extracorporeal | 7 exchanges over 14 days (typical) | PEXIVAS — NOT routine; selective for dialysis-dependent / severe AKI from GN or DAH; standard of care if concomitant anti-GBM |
Plan: MPA — severity triage → induction (GC PEXIVAS taper + RTX/CYC ± PEX ± avacopan) → prophylaxis → maintenance → ILD → relapse/ESKD (2021 ACR/VF + KDIGO 2024)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Prolonged maintenance (rituximab or azathioprine) with relapse surveillance; ESKD pathway and kidney transplant timing (defer until sustained remission); MPA-ILD progression monitoring ± antifibrotic; long-term CV risk modification, infection prophylaxis, malignancy surveillance (CYC bladder/hematologic); vaccination (avoid live vaccines on immunosuppression); fertility/family planning
Guideline: 2021 ACR/VF Vasculitis Guideline (ANCA-associated) + KDIGO 2024 ANCA GN + 2022 ACR/EULAR classification + PEXIVAS/ADVOCATE/RAVE