A 34-year-old Renal Transplant Recipient with High-Grade Fever and Progressive Shortness of Breath

A 34-year-old man was referred for evaluation of renal failure. The illness had started with a 2-month history of easy fatiguability, nausea and vomiting which was followed by puffiness of face and oedema feet and a decrease in urinary output. He did not provide a long-standing history of renal symptomatology or that of any systemic disorder. His past medical history revealed a fully treated tuberculous lymphadenitis, 8 years prior to presentation and a history of multiple unprotected sexual encounters with penile ulcerations on 3 occasions, treated with unspecified medications. He was a chronic smoker, but a teetotaler. On presentation, he had clinical features of uncontrolled hypertension (170/116 mm of Hg) with grade III hypertensive retinopathy, facial and pedal oedema and cardiac failure. Investigations revealed a haemoglobin concentration of 7.6 gm%, mild leucocytosis (neutrophils 80%, lymphocytes 20%); urine protein 2+ with 12-15 red blood cells per high power field; Blood urea nitrogen 65 mg% and creatinine 14.4 mg%. Sonographic examination revealed normal sized kidneys