Which immunosuppressant may enhance methotrexate nephrotoxicity?

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Multiple Choice

Which immunosuppressant may enhance methotrexate nephrotoxicity?

Explanation:
Methotrexate is cleared by the kidneys, so anything that harms renal function or reduces its clearance can raise methotrexate exposure and nephrotoxicity. Cyclosporine is a well-known nephrotoxic immunosuppressant that lowers GFR through afferent arteriolar vasoconstriction and direct tubular effects. This combination can significantly increase methotrexate levels and the risk of kidney injury. The other agents listed are either less nephrotoxic or do not have as clear a impact on methotrexate clearance, so they are less likely to enhance its nephrotoxicity.

Methotrexate is cleared by the kidneys, so anything that harms renal function or reduces its clearance can raise methotrexate exposure and nephrotoxicity. Cyclosporine is a well-known nephrotoxic immunosuppressant that lowers GFR through afferent arteriolar vasoconstriction and direct tubular effects. This combination can significantly increase methotrexate levels and the risk of kidney injury. The other agents listed are either less nephrotoxic or do not have as clear a impact on methotrexate clearance, so they are less likely to enhance its nephrotoxicity.

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