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. |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::Cyclosporine, WBRKeyword::Renal biopsy, WBRKeyword::Tubulointerstitial damage, WBRKeyword::Focal segmental glomerulosclerosis, WBRKeyword::Adverse effect |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |