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HCQ Retinal Toxicity Risk CKD — ESENeph MCQ

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ModerateChronic Kidney DiseaseHCQ Retinal Toxicity Risk CKDESENeph

A 40-year-old woman with CKD G3a from lupus nephritis has achieved sustained remission for 3 years. She is on low-dose Mycophenolate (500 mg BD) and Hydroxychloroquine. Her rheumatologist asks about ophthalmological monitoring for Hydroxychloroquine. At what cumulative dose does retinal toxicity risk increase substantially?

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Correct answer: D — Risk increases significantly after 5 years of use or cumulative dose >1000 g

Hydroxychloroquine retinal toxicity risk increases with cumulative dose (generally after >1000 g total or >5 years of use), daily dose >5 mg/kg actual body weight, and concurrent CKD (reduced drug clearance). RCOphth 2020 recommends annual screening after 5 years. In CKD, screening may need to start earlier as drug accumulation is increased. The maximum recommended dose in CKD is lower than in normal renal function.

Reference: RCOphth 2020 – HCQ Screening; KDIGO 2024 – LN