A man in his 20s with poorly controlled type 1 diabetes mellitus was admitted for osteomyelitis of the left lower leg and acute on chronic kidney disease. His systolic blood pressure was higher than 180 mm Hg, and he was noted to have anasarca. Laboratory examination demonstrated hypoalbuminemia and hyperphosphatemia in addition to clinically significant elevations of blood urea nitrogen and creatinine levels from baseline. Urine studies showed nephrotic range proteinuria. The patient’s renal injury, blood pressure, and fluid overload did not improve despite removal of all potential nephrotoxic agents and aggressive titration of antihypertensive and diuretic medications. In the setting of acute on chronic kidney disease, infection, and difficult-to-control hypertension, a renal biopsy was considered to determine definitive diagnosis.
Mehta HN, Chi X, Buckhold FR. Hidden Risks of Blood TransfusionsA Teachable Moment. JAMA Intern Med. 2015;175(9):1445-1446. doi:10.1001/jamainternmed.2015.2933