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MRCP Part 2 Written Question of the Day

Try our Question of the Day and test your knowledge. Questions include themes similar to November 2011 MRCP Part 2 Written exam.

A 60-year-old man with Wegener's granulomatosis, previously treated with cyclophosphamide, and pulse methylprednisolone is on cyclosporine (100 mg/day), and on a reducing course of oral prednisolone (15 mg/day to 7.5 mg/day) for the last two months.

His vasculitis is well controlled. He was found to have worsening hypertension, despite starting on amlodipine and doxazosin. Urine dipstick and renal ultrasound are normal. He has normal inflammatory markers and FBC over the last few months.

His blood tests are as follows:

  0 week 2 weeks 6 weeks 8 weeks
BP (mm Hg) 140/90 145/95 150/100 160/110
Na  (mmol/l) 142 140 141 139
K (mmol/l) 4.5 4.7 5.0 5.0
Urea (µmol/l) 10.2 12.4 12.6 14.2
Creat (µmol/l) 110 135 170 190

What is the most likely cause for deteriorating renal function?

(Please select 1 option)

Cushing's syndrome
Cyclosporine toxicity
Delayed reaction to cyclophosphamide
Glomerulonephritis due to vasculitis
Hypertension

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