<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 57-year-old woman comes to the clinic complaining of decreased urine output. She reports that over the past 2 weeks she has been urinating less and less every day. She denies changes in her diet or fluid intake. The patient has a history of lupus nephritis, which has resulted in end stage renal disease. She underwent a renal transplant 2 months ago. Since then she has been on mycophenolate and cyclosporine, which she takes as prescribed. The patients temperature is 99F 37.2C, blood pressure is 172102 mmHg, pulse is 88min, and respirations are 17min with an oxygen saturation of 97 on room air. Labs show an elevation in serum creatinine and blood urea nitrogen. On physical examination, she has 2 pitting edema of the bilateral lower extremities. Lungs are clear to auscultation. Urinalysis shows elevated protein. A post-void bladder scan is normal. A renal biopsy is obtained, which shows lymphocyte infiltration and intimal swelling. Which of the following is the next best step in management?? A: Add ceftriaxone, B: Add diltiazem, C: Discontinue cyclosporine, D: Nephrectomy, E: Start intravenous steroids,  <response>: This is a question about a 57-year-old woman with a history of lupus nephritis and recent renal transplant who is now presenting with decreased urine output, elevated blood pressure, edema, elevated serum creatinine and BUN, proteinuria, and a renal biopsy showing lymphocyte infiltration and intimal swelling. The key findings are: - Recent renal transplant due to lupus nephritis- On immunosuppressants cyclosporine and mycophenolate- Presenting with signs of acute kidney injury including decreased urine output, elevated creatinine and BUN, edema- Renal biopsy shows lymphocyte infiltration suggestive of rejectionThe choices include adding an antibiotic ceftriaxone, antihypertensive diltiazem, discontinuing the immunosuppressant cyclosporine, removing the transplanted kidney, and starting steroids. This presentation is most consistent with acute rejection of the transplanted kidney. The lymphocyte infiltration on biopsy supports this. Therefore, the best next step would be to start high dose intravenous steroids to treat the presumed acute rejection.E: Start intravenous steroids 