55-year-old male with post renal transplant with worsening renal function, HTN and gout attacks.

freecme000
Published on May 3, 2022
55-year-old male with history of living related kidney transplant 7 years ago on chronic immunosuppression ( prograf, cellcept and prednisone) and PMH significant for htn, gout presents with worsening renal function (creatinine increasing from 1.2 to 3.2 range over the past 4 year) with increasing frequency of gout attacks over past one year.

VITALS - BP 165 /100 mm hg, RR 16, Afebrile. weight 155 pounds, Gum exam showed very thin, black-blue line visible along the margin of the gums, at the base of the teeth, no gout tophi seen.

DIAGNOSITICS -
Urine shows positive for glucose and mild proteinuria in 500 mg per day range without any hematuria - Uric acid is 10.0 range, creat 3.2 mg/dl. Renal U/s shows medical renal disease with increased cortical echogenicity. Renal biopsy shows no evidence of rejection but showed evidence of chronic interstitial fibrosis and tubular atrophy.

Currents Meds - prograf, cellcept and prednisone, and Lisinopril.
Occupation - works in ammunition factory for past 6 years.

Most likely primary reason for worsening renal failure is -

A. HTN related nephrosclerosis
B. Chronic gout related CKD
C. Heavy Metal exposure in occupation
D. Calcineurin ( prograf)induced nephrotoxicity

CLICK ON LINK BELOW FOR ANSWER

https://renal.medcase.com/free_cme/55-year-old-male-with-post-renal-transplant-with-worsening-renal-function-htn-and-gout-attacks/