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Hydroxychloroquine Retinal Screening — ESENeph MCQ

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HardGlomerulonephritisHydroxychloroquine Retinal ScreeningESENeph

A kidney-transplant recipient has slowly rising creatinine, hypertension and hyperkalaemia. Biopsy excludes rejection and BK nephropathy but shows arteriolar hyalinosis and striped interstitial fibrosis. What is the most appropriate response?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Calcineurin-inhibitor reduction while maintaining sufficient anti-rejection cover

Explanation lettering: E = shown as A · A = shown as B · D = shown as C · B = shown as D · C = shown as E

E is correct. In the stated context, hypertension, hyperkalaemia and biopsy evidence of arteriolar and striped chronic injury support calcineurin-inhibitor toxicity after important mimics have been excluded. Management is a supervised reduction in exposure or carefully selected conversion strategy while preserving adequate rejection prophylaxis. A treats pathology that the biopsy explicitly did not show. B increases the suspected toxic exposure. C creates a high risk of catastrophic rejection. D ignores the vascular and interstitial pattern. Because these lesions are not perfectly specific, trough history, interactions, adherence and the complete biopsy are reviewed before a material regimen change.

Reference: KDIGO transplant-recipient guideline: https://kdigo.org/wp-content/uploads/2017/02/KDIGO-2009-Transplant-Recipient-Guideline-English.pdf