20th February 2025

A 63-year-old woman presents with haemoptysis, malaise and blood in her urine followed by reduced urine output.

A 63-year-old woman presents with haemoptysis, malaise and blood in her urine followed by reduced urine output. Her observations are normal except for a blood pressure of 170/90 mmHg and a 1 L oxygen requirement via nasal cannulae. Her ECG is normal and her urine dipstick shows 3+ blood and 3+ protein. Her bloods are as follows:

Sodium 136 mmol/L (normal: 135 – 145 mmol/L)

Potassium 5.3 mmol/L (normal: 3.5 – 5.5 mmol/L)

Urea 28 mmol/L (normal: 2.0 – 7.0 mmol/L)

Creatinine 380 micromol/L (normal: 55 – 120 micromol/L)

pH 7.35 (normal: 7.35 – 7.45)

Bicarbonate 21 mmol/L (22 – 28 mmol/L)

Her platelets and clotting are normal. A renal screen is sent.

A chest radiograph shows bilateral infiltrates and a subsequent high-resolution CT thorax shows alveolar haemorrhage. A CT of the urinary tract shows unobstructed and normal-sized kidneys.

Which of the following treatment options should be started?

Select the SINGLE most appropriate option from the list below. Select ONE option only.