MRCP 1

1. A 67-year-old man with Wegener's granulomatosis, previously treated with cyclophosphamide, is currently on azathioprine.
His vasculitis is well controlled. He was found to have microscopic haematuria on two occasions a month apart. Urine culture showed no growth. There is no proteinuria, abdominal pain, and a renal ultrasound is normal.
He has normal inflammatory markers and stable urea electrolytes and creatinine over the last year.
What is the next step in his management?
(Please select 1 option)

A. Cystoscopy
B. Prolonged urinary culture
C. Renal angiogram
D. Renal biopsy
E. Urine culture for TB

Answer: A

Cyclophosphamide causes haemorrhagic cystitis, and increases the risk of developing bladder cancer in the future. The risk increases with increasing doses of cyclophosphamide.

Renal biopsy is not indicated as there is no evidence of active renal vasculitis - normal inflammatory markers, stable creatinine.

Renal angiogram is used to investigate renal artery stenosis.

Renal tract TB is unlikely in the absence of proteinuria