The patient is experiencing ischemic acute
tubular necrosis. The toxic form of acute tubular necrosis is caused by
nephrotoxic agents such as drugs and toxins. The ischemic form is
caused by sepsis, shock, or trauma. The 60-year-old man received a
blood transfusion as a result of a car accident. Thus, he experienced
trauma and the reaction to the blood transfusion caused him to
experience a septic shock which is characterized by dizziness, fever,
and chills. Acute tubular necrosis is characterized by oliguria, a
slightly cloudy urine appearance, and the presence of RBC, WBC, renal
epithelial cells, and granular casts in the urine. The patient exhibits
all of these signs. Patients with acute tubular necrosis may also have
protein in their urine as well as a low specific gravity (as seen with
this patient).