I recently treated the below patient and would like to ask your opinion:
61 year old caucasian male with long standing diabetes-2 on insulin with baseline creatinine of 1.2-1.5 presented with left lower extremity swelling and fever. No h/o diabetic retinopathy. PMH includes CAD s/p CABG, charcots foot with recurrent right lower extremity cellulitis leading to right BKA. Creatinine at the time of this admission was 3.4. Has MRSA bacteremia and left lower extremity osteomyelitis of foot. Treated with daptomycin initially and then changed to lenezolid. Initial evaluation revealed 0.6 grms of proteinuria. Over a period of few days creatinine improved to 1.6. But started to worsen again gradually over next 10 days with peak creatinine of 3.8 and BUN 116. Developed fluid retention leading to pulmonary edema. Has worsening leukocytosis. He was started on Hemodialysis via right IJ tunnelled catheter.
1) What would be the cause of his recurrent AKI?
2) Would you do biopsy?
3) Any other investigations?
61 year old caucasian male with long standing diabetes-2 on insulin with baseline creatinine of 1.2-1.5 presented with left lower extremity swelling and fever. No h/o diabetic retinopathy. PMH includes CAD s/p CABG, charcots foot with recurrent right lower extremity cellulitis leading to right BKA. Creatinine at the time of this admission was 3.4. Has MRSA bacteremia and left lower extremity osteomyelitis of foot. Treated with daptomycin initially and then changed to lenezolid. Initial evaluation revealed 0.6 grms of proteinuria. Over a period of few days creatinine improved to 1.6. But started to worsen again gradually over next 10 days with peak creatinine of 3.8 and BUN 116. Developed fluid retention leading to pulmonary edema. Has worsening leukocytosis. He was started on Hemodialysis via right IJ tunnelled catheter.
1) What would be the cause of his recurrent AKI?
2) Would you do biopsy?
3) Any other investigations?
