A 56-year-old man comes to the physician for a 3-day history of progressive fatigue and feelings of general unwellness. This is on a background of autosomal dominant polycystic kidney disease for which he received a cadaveric renal transplant six months ago. Current medications include prednisone, sirolimus, simvastatin, and amlodipine. Laboratory studies show a creatinine of 2.3 mg/dL and blood urea nitrogen of 45 mg/dL. A renal biopsy shows intranuclear inclusions. Which of the following is the next best step in management?
Commence ganciclovir therapy
Decrease dose of sirolimus
Discontinue sirolimus and switch to tacrolimus
Increase dose of prednisone
Repeat biopsy in 3 months
Repeat biopsy in 6 months
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Cut-to-the-chase Answer (0:21):
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HY USMLE Answer (7:58):
