Explain a new diagnosis of granulomatosis with polyangiitis and the long-term plan — OSCE

Candidate brief

You have eight minutes to explain a new diagnosis of granulomatosis with polyangiitis to a 14-year-old boy and his parents. He presented with three weeks of bloody nasal discharge, a septal ulcer, a cough and cola-coloured urine. The PR3 (c-ANCA) is positive and the renal biopsy shows a crescentic pauci-immune glomerulonephritis. The induction therapy with rituximab and glucocorticoids is about to start. The parents have read online that the disease causes kidney failure and is lifelong, and the boy is worried about the steroid side effects. Use a structured, honest, empathic approach that names the diagnosis, explains the mechanism in plain language, addresses the online fears and the steroid worry, and builds a clear treatment and surveillance plan. ^[7][6]