After a poor response to steroids, followed by a 6‐month trial of cyclophosphamide, he was commenced on
cyclosporin in January 1997.
In October 1998 the patient complained of lethargy and tiredness. Examination was unremarkable, other than blood pressure 150/100. Investigations revealed Hb 8.7, with normal red cell parameters, ferritin 23, folate 6.1, creatinine 240, urea 21.8, corrected calcium 2.20, and phosphate 1.33.