WBR1017

Author	[[PageAuthor::Ogheneochuko Ajari, MB.BS, MS [1] (Reviewed by Yazan Daaboul, M.D.)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pharmacology
Sub Category	SubCategory::Renal
Prompt	[[Prompt::A 35-year-old woman develops hypertension and creatinuria approximately 6 months following drug therapy. Urinalysis is negative for proteinuria. Renal biopsy demonstrates tubulointerstitial damage and focal segmental glomerulosclerosis. Which of the following is the most likely causative agent?]]
Answer A	AnswerA::Penicillin G
Answer A Explanation	AnswerAExp::Penicillin G is typically associated with acute hypertensive interstitial nephritis.
Answer B	AnswerB::Gentamicin
Answer B Explanation	AnswerBExp::Gentamicin is typically associated with acute tubular necrosis.
Answer C	AnswerC::Cyclosporine
Answer C Explanation	AnswerCExp::Cyclosporine-associated nephrotoxicity typically manifests with tubulointerstitial damage and focal segmental glomerulosclerosis.
Answer D	AnswerD::Naproxen
Answer D Explanation	AnswerDExp::Naproxen is typically associated with chronic analgesic nephropathy but usually manifests first as papillary necrosis.
Answer E	AnswerE::Cyclophosphamide
Answer E Explanation	AnswerEExp::Cyclophosphamide is typically associated with cystitis.
Right Answer	RightAnswer::C
Explanation	[[Explanation::Cyclosporine is an immunosuppressant recommended among patients with autoimmune disorders and for the suppression of organ rejection following transplantation. It binds to cyclophilins, whereby the formed complex blocks the differentiation and activation of T-cells by inhibiting calcineurin. Subsequently, calcineurin prevents the production of IL-2 and its receptors. Cyclosporine is typically associated with nephrotoxicity and hypertension. On renal biopsy, cyclosporine nephrotoxicity typically manifests with tubulointerstitial damage and focal segmental glomerulosclerosis. Other adverse effects of cyclosporine include hyperlipidemia, hyperglycemia, tremor, hirsutism, and gingival hyperplasia. Educational Objective: Adverse effects of cyclosporine include nephrotoxicity, hypertension, hyperlipidemia, hyperglycemia, tremor, hirsutism, and gingival hyperplasia. Cyclosporine-associated nephrotoxicity typically manifests with tubulointerstitial damage and focal segmental glomerulosclerosis. References: Tedesco D, Haragsim L. Cyclosporine: a review. J Transplant. (2012), Article ID 230386, 7 pages. First Aid 2015 page 218.]]
Approved	Approved::Yes
Keyword	WBRKeyword::Cyclosporine, WBRKeyword::Renal biopsy, WBRKeyword::Tubulointerstitial damage, WBRKeyword::Focal segmental glomerulosclerosis, WBRKeyword::Adverse effect
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