Subject participating in protocol. Dosed on 05/26/2022 with past medical history of Medullary cystic kidney disease for which underwent a right nephrectomy in 1984, history of CKD stage V status post living unrelated donor transplant 5/2021 who is currently on tacrolimus and mycophenolate, history of supra vena carva syndrome thrombosis with a recent stent placed and on chronic warfarin, seizure disorder, hypertension who presented to ER on 3/10/2023. The patient says that about 1 day prior to hospitalization, developed fevers and chills and right-sided abdominal pain at the site of allograft that was 7 out of 10 in intensity and associated with some nausea. Subject had some test done in the outpatient setting and that the urine was concerning for infection and was told to present to the ER for further evaluation. Patient presented with sepsis secondary to right-sided pyelonephritis involving her transplanted kidney was treated aggressively with IV antibiotics Patient developed kidney injury and fluid retention Treated with IV Lasix and improved significantly. Subject denies any difficulty breathing or cough. Upon presentation the patient was found to have a blood pressure of 141/78 and a temperature of 99.8 degrees F. Admission labs showed a creatinine of 1.6, normal LFTs, WBC count of 22, she had a CT of the abdomen pelvis (3/11/2023) that showed concerns for pyelonephritis of the right-sided kidney transplant with trace associated fluid. Subject had a chest x-ray (3/10/2023) that showed mild pulmonary vascular congestion. ECG 12 lead on 3/10/2023 was normal, Urine culture on 3/10/2023 grew E. coli and so did blood culture. Initially on meropenem and then was given a dose of tobramycin on 3/12/2023 given that subject continued to spike fevers. 3/14/2023: XR Chest 1 View Narrative: HISTORY f/up F/U, FLANK PAIN, HAVING MILD shortness of breath F single view of the chest demonstrates bibasilar airspace disease. Left-sided Port-A-Cath is demonstrated. There is a stent presumptively in the supra vena carva . Small effusions are noted. There is no evidence of pneumothorax. Cardiac silhouette is enlarged. CONCLUSION Findings are similar to previously likely representing degree of volume overload/CHF. Bibasilar density may be atelectatic change or pneumonia. 3/15/2023: Over the past 24 hours the patient remains afebrile with a Tmax of 100 degrees F, and hemodynamically stable and she is on 2 L of supplemental oxygen via nasal cannula. She says that her right kidney is feeling better and it is she is not as tender as it was before. patient still feeling a little bit short of breath was evaluated by pulmonology on 3/14/2023 and they recommended continuing diuresis. 3/16/2023: Over the past 24 hours the patient started on maintenance afebrile, and hemodynamically stable. Patient stated shortness of breath has improved and that is still being diuresed. denied any diarrhea and reports continued improvement of the pain of her transplant kidney.  Physical Examination on day of discharge: Temp [98.3 degrees F (36.8 degrees C)-98.6 degrees F (37 degrees C)] 98.6 degrees F (37 degrees C) Pulse: [58-69] 69 Resp: [19-20] 20 BP: (116-132)/(64-76) 118/66 General: Nontoxic Cardiac: S1-S2 audible Respiratory: Normal lung sounds Diagnosis Date Noted ? Sepsis with acute renal failure without septic shock, due to unspecified organism, unspecified acute renal failure ? Acute pyelonephritis Okay to discharge today on oral antibiotics Admission Date: 3/10/2023 Discharge Date: 03/16/23 Awaiting Principal investigator to give causality (pending)