A 38-Year-Old Woman Comes to the Office with 2 Weeks

question 602

Multiple Choice

A 38-year-old woman comes to the office with 2 weeks of mild headache and nausea.  She has a history of end-stage renal disease secondary to lupus nephritis and had an allograft renal transplant a year ago.  Her medications include tacrolimus, azathioprine, and prednisone.  The patient has also been taking lansoprazole for indigestion for the past 3 weeks.  She does not use tobacco, alcohol, or illicit drugs.  To take better care of herself, she has begun eating plenty of fruits and green vegetables and drinking grapefruit juice.
The patient is afebrile.  Her blood pressure was 120/70 mm Hg a month ago and is now 150/90 mm Hg.  Examination shows clear lung fields, normal heart sounds, and a soft and nontender abdomen.  She has mild bilateral hand tremor without muscle weakness or sensory loss.  There is no lower extremity edema.
Laboratory results are as follows:

Urinalysis shows clear urine with no protein, blood, cells, or casts.  Renal ultrasound shows no abnormalities of the transplanted kidney with no urinary leak or obstruction.
Which of the following is the most likely cause of this patient's renal failure?

• A)Acute transplant rejection
• B)BK virus infection
• C)Hypertensive nephrosclerosis
• D)Recurrence of lupus nephritis
• E)Tacrolimus toxicity

---

Definitions:

Electron Transport System

A series of protein complexes located in the mitochondria or chloroplasts that transfer electrons, creating an electrochemical gradient to produce ATP.

ATP

Adenosine triphosphate, a molecule that carries energy within cells for metabolism.

NADPH

Nicotinamide adenine dinucleotide phosphate, a cofactor used in anabolic reactions, such as lipid and nucleic acid synthesis, serving as a reducing agent by donating electrons and hydrogen.

Theodor Engelmann

A 19th-century German biologist and physician known for his work on photosynthesis and the action spectrum of chlorophyll.