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This biopsy is from a 9-year-old boy who developed pediatric nephrotic syndrome in the first year of life and has been maintained on cyclosporine (CSA) due to frequent relapses. He had not had a biopsy before and was clinically on remission, considering switching to rituximab. The biopsy was performed to assess chronic changes and the presence of histologic signs of chronic calcineurin inhibitor (CNI) toxicity CNI toxicity. His serum creatinine was 0.6 mg/dL. He was also on lisinopril for proteinuria control. He was not hypertensive. The biopsy contained a total of 61 glomeruli, four of which were globally sclerotic. No...