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Ciclosporin Chronic Nephrotoxicity FSGS — ESENeph MCQ

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ModerateGlomerulonephritisCiclosporin Chronic Nephrotoxicity FSGSESENeph

A 55-year-old woman with FSGS on Ciclosporin develops hirsutism, gingival hyperplasia, and tremor. Her creatinine has risen by 25% over 6 months. What complication of Ciclosporin is most concerning for long-term kidney health?

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Correct answer: C — Chronic CNI nephrotoxicity – characterised by progressive interstitial fibrosis and arteriolar hyalinosis (striped fibrosis pattern), which may be indistinguishable from chronic allograft nephropathy in transplant patients

While cosmetic side effects (hirsutism, gingival hyperplasia) and neurological effects (tremor) are common with Ciclosporin, the most clinically concerning long-term complication is chronic CNI nephrotoxicity. This manifests as progressive interstitial fibrosis with a characteristic 'striped' pattern and arteriolar hyalinosis (nodular hyaline deposits in afferent arterioles). It is dose- and duration-dependent and may be irreversible. The rising creatinine suggests developing nephrotoxicity. Management involves CNI dose reduction, switching to Tacrolimus (which has a different side effect profile but still causes nephrotoxicity), or transitioning to a CNI-free regimen.

Reference: KDIGO 2021 – GN Guideline; Naesens et al 2009 – CNI Nephrotoxicity