A 58-Year-Old Woman Comes to Clinic for Follow-Up

question 1155

Multiple Choice

A 58-year-old woman comes to clinic for follow-up.  She has a history of end-stage renal disease due to polycystic kidney disease and underwent renal transplantation 2 years ago.  Two months ago, the patient was diagnosed with paroxysmal atrial fibrillation.  She had been feeling well until the past several weeks when she noticed decreased urine output and mild fatigue.  Current medications include diltiazem, apixaban, prednisone, tacrolimus, and mycophenolate sodium.  Temperature is 37 C (98.6 F) , blood pressure is 152/86 mm Hg, pulse is 82/min, and respirations are 12/min.  Abdominal examination reveals no tenderness to palpation.  Laboratory results reveal a serum creatinine of 2.3 mg/dL, which is increased from her baseline of 1.4 mg/dL that was last checked 2 months ago.  Urinalysis with microscopy is as follows: Blood tacrolimus level is moderately elevated.  Transplant ultrasound reveals no hydronephrosis.  Which of the following is the most likely cause of this patient's worsening renal function?

• A)Acute interstitial nephritis
• B)Acute tubular necrosis
• C)Antibody-mediated rejection
• D)Arteriolar vasoconstriction
• E)Polyoma virus reactivation