Hypertension and Acute Kidney Injury following an Allograft Biopsy.

Abstract

### Case Answer A 49-year-old woman was admitted with 2 weeks of progressive dyspnea, edema, and hypertension. Medical history is significant for ESKD attributed to hypertensive nephrosclerosis. She underwent a deceased-donor kidney transplant 2 months before admission. The post-transplant serum creatinine concentration reached a nadir of 2.0 mg/dl. An allograft biopsy performed 2.5 weeks before admission revealed acute cellular rejection (Banff borderline). She was treated with steroids. Physical examination on admission was notable for tachypnea at 24 breaths/min, BP of 180/95 mm Hg, pulse of 91/min, with oxygen saturation of 98% on 5 L of oxygen. Pertinent findings included bilateral 3+ pitting edema, crackles, and wheezing. Laboratory evaluation revealed serum sodium of 134 mmol/L, potassium of 4.6 mmol/L, bicarbonate of 16 mmol/L, BUN of 94 mg/dl, and serum …