Treatment for renal failure is recommended. Blood pressure, GI protectants, and IV Ampicillin is warranted given the strong potential for Leptospirosis. Plasma transfusion with plasma expanders would be ideal. Urine culture and sensitivity is warranted. Assessment for toxin exposure would also be recommended such as Aflatoxin or plant ingestion.  Core renal biopsy may be necessary. Dialysis would be ideal if refractive to therapy.

Note: The pericapsular renal fluid accumulation is a frequent sonographic finding in cases of Leptospirosis that we see in the northeast United States, the elevated renal _/- liver enzymes wiht depression and relkatively minor sturctural renal changes wiht pericapsular fluid accumulation is a personal red flag for leptospirosis. Of course other acute renal insults can do this but since the northeast uinited states is endemic for leptsopirosis we must consider it on the forefront, especially in the days following heavy rain in the region.