A 59-year-old woman with a history of Type 2 diabetes mellitus was found unconscious at home by her family members. In the emergency center, she was noted to have a temperature of 38.6°C, pulse rate of 112 beats/ minute, blood pressure of 96/50 mmHg, and respiratory rate of 26 breaths/minute. After infusion of 2 L of normal saline, the patient became more alert and began to answer the questions more appropriately. Laboratory values revealed WBC- 26,000/mm3, hemoglobin 12 g/dl, normal platelet count, and a serum glucose level of 280 mg/dL.
A Foley catheter was placed that showed a return of concentrated and cloudy urine. The urinalysis revealed 50 WBC per high-power field. Abdominal CT scan without contrast revealed no free fluid in the abdomen and an inflamed right kidney with perinephric fat stranding. Shortly after the patient was transferred to the ICU, her nurse notified that her…
