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A 56-year-old woman with a history of primary pulmonary hypertension and heart and lung transplantation was admitted to the hospital because of renal failure.
When the patient was approximately 43 years old, a diagnosis of primary pulmonary hypertension was made at another institution; progressive hypoxemia and polycythemia developed, and 3 years later (10 years before admission), heart and lung transplantation was performed at another hospital. The patient's symptoms improved, and oxygenation and hemoglobin levels returned to normal. Her medications included prednisone (10 mg daily), cyclosporine (225 mg twice daily), azathioprine (75 mg per day in divided doses), folate, hydralazine, furosemide,
Differential Diagnosis
Chronic Kidney Disease in Nonrenal Solid-Organ Transplantation
Diabetic and Hypertensive Nephropathy
Glomerular Disease
Tubulointerstitial Disease
Vascular Disease
Complications of Immunosuppressive Drugs
Calcineurin Inhibitors
TOR Inhibitors
Clinical Diagnosis
Dr. Nelson B. Goes's Diagnosis
Pathological Discussion
Focal Segmental Glomerulosclerosis, Collapsing Variant
Glomerular Collapse as a Form of Cyclosporine Toxicity
Cyclosporine-Mediated Arteriolopathy
Anatomical Diagnoses
Source Information
From the Nephrology Division, Department of Medicine (N.B.G.), and the Department of Pathology (R.B.C.), Massachusetts General Hospital; and the Departments of Medicine (N.B.G.) and Pathology (R.B.C.), Harvard Medical School.
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