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Acute kidney injury in the setting of Legionella pneumonia. This biopsy is a middle-aged person with Legionella pneumonia who developed acute kidney injury. Early in the hospitalization, the baseline creatinine was 1.0 mg/dl. However, the creatinine rose to 6.5 over 5 days and Nephrology was consulted. Urinalysis showed microscopic hematuria and 2+ proteinuria. The creatinine increased to 7.5 and a biopsy was done. Serologic studies were ordered and were pending at the time of biopsy. The images provided show a combination of acute tubular injury (Image 1), mild mesangial matrix expansion (Image 2) and mesangial IgA deposits (Image 3). While...