A renal transplant recipient has been maintained on immunosuppressive therapy for three years with Sandimmune (cyclosporine). A primary concern for this client is the development of: A. Hepatotoxicity B. Hirsutism C. Bone loss D. Nephrotoxicity

Cyclosporine is an immunosuppressive medication used to prevent rejection of transplanted organs. It works by suppressing the body's immune system, which can otherwise attack the transplanted organ.

Like any other medication, cyclosporine has potential side effects. Some common side effects include: 1. Hepatotoxicity (liver damage) 2. Hirsutism (abnormal hair growth) 3. Bone loss 4. Nephrotoxicity (kidney damage)

Among the given options, not all side effects occur with equal severity or frequency. Let's assess the primary concern by looking at both these factors: A. Hepatotoxicity - While liver damage is a possible side effect of cyclosporine, it is less common and less severe than some other side effects. B. Hirsutism - Although hirsutism is a relatively common side effect, it is not a significant health concern and is primarily a cosmetic issue. C. Bone loss - Bone loss is a potential concern due to the use of corticosteroids in combination with cyclosporine, but it is still not as significant a concern as nephrotoxicity. D. Nephrotoxicity - Nephrotoxicity is both a common and severe side effect of cyclosporine, with up to 40% of patients experiencing some form of kidney dysfunction and a increased risk of chronic kidney disease in the long term.

Given the analysis of the potential side effects of cyclosporine, the primary concern for a renal transplant recipient on immunosuppressive therapy for three years would be the development of nephrotoxicity (Option D), due to its higher likelihood and potential severity.