A 67-year-old female patient with chronic kidney disease (CKD) stage 5 in dialysis is admitted to the nephrology service for treatment of pyelonephritis. She is hypertensive, medicated and controlled. Displays history of repeated episodes of sepsis with probable renal focus. At admission the patient was pale (2+/4+), with mild hepatosplenomegaly and palpable masses in topography of kidneys. All other parts of the examination remain unchanged.