Renu Sharma, a 28-year-old school teacher, walked into the nephrology OPD with what seemed like a routine complaint — recurrent fevers, right-sided flank pain, and urinary urgency. She’d been treated multiple times over the past year for urinary tract infections, but this time felt different. Her fatigue lingered longer, and she’d started noticing cloudy, foul-smelling urine, occasional weight loss, and a general sense of malaise. Her history revealed a severe UTI during adolescence that had required hospitalization, and a habit of holding in urine due to her demanding job schedule.
On examination, she appeared pale, with low-grade fever and tenderness at the right renal angle. Her blood pressure was slightly elevated. Urinalysis showed significant pyuria, mild proteinuria, and the presence of bacteria — with culture confirming resistant E. coli. Blood tests revealed mild anemia and raised serum creatinine. However, it was the ultrasound that told the real story: her right kidney was smaller than normal, irregular in shape, and showed signs of cortical scarring and hydronephrosis.