Ciclosporin nephrotoxicity — MRCPCH TAS MCQ

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HardPharmacologyCiclosporin nephrotoxicityMRCPCH TAS

A 12-year-old with steroid-resistant nephrotic syndrome starts an immunosuppressant. Two weeks later creatinine rises and blood pressure is high; trough level is above target. Which drug is most likely responsible?

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Correct answer: D — Ciclosporin

Ciclosporin is a calcineurin inhibitor with dose-related nephrotoxicity and hypertension, making trough monitoring important. Mycophenolate commonly causes gastrointestinal upset and marrow suppression rather than calcineurin-related renal vasoconstriction. The pearl is that therapeutic drug monitoring can prevent toxicity from narrow-index immunosuppressants.

Reference: BNFc; Nelson Textbook of Pediatrics; RCPCH Theory examination syllabi