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A 52-Year-Old Man Comes to the Clinic for Follow-Up

question 45

Multiple Choice

A 52-year-old man comes to the clinic for follow-up. The patient has a history of diabetes mellitus type 2 and end-stage renal disease due to diabetic nephropathy. He underwent living donor kidney transplantation 5 months ago. The patient's immunosuppression regimen includes prednisone, tacrolimus, and mycophenolate sodium, and he also takes insulin. At his last clinic visit 3 months ago, he had good renal graft function with serum creatinine of 1.2 and trace proteinuria. In the interim, the patient has had no symptoms other than mild fatigue. Temperature is 37.3 C (99.1 F) , blood pressure is 146/82 mm Hg, pulse is 78/min, and respirations are 12/min. Physical examination is unremarkable. Laboratory studies are as follows: Urinalysis shows 1+ glucose and 2+ protein and is otherwise unremarkable. Biopsy of the transplanted kidney reveals heavy lymphocyte infiltration with vascular involvement and swelling of the intima. Which of the following is the most likely cause of this patient's renal dysfunction?

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