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* 1. A 54-year-old woman presents to your office complaining of swelling of her legs that has gradually worsened over the last 3-4 months. She has a history of mild heart failure, and her chronic medications include lisinopril 20 mg QD, chlorthalidone 25 mg QD and atorvastatin 20 mg QD. Her older brother received a kidney transplant 20 years ago. An evaluation reveals BP 148/86, bilateral pedal edema to the mid-calf. Her serum creatinine is 0.8 mg/dL, albumin 2.1 g/dl, and cholesterol is 357 mg/dl. Her urine protein:creatinine ratio is 7.5 (mg:mg). She is started on corticosteroids. Unfortunately, she develops severe hyperglycemia, and the therapy is discontinued without any improvement in herproteinuria[BJ1] [DB2] . A diagnostic kidney biopsy is performed and demonstrates FSGS. She inquires about clinical trials of endothelin antagonists that she has learned about on the internet.

Which of the following adverse events that is related to the drug action is most likely to occur in this patient?

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* 2. What is your level of confidence that your choice is correct?

Pre-conference considerations:

Would treatment with an endothelin antagonist interact with any of her medications?

Does her family history influence the decision to consider treatment with an endothelin antagonist?

What underlying comorbid condition is important to assess?

What side effects might this patient experience if she is treated with an endothelin antagonist?

Is there any way to predict her response to an endothelin antagonist?
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