Features consistent with renal papillary necrosis of the medullary subtype with a left-sided ball-on-tee appearance. There is calyceal blunting likely following papillary sloughing and epithelialization on the right.

There was clinical and radiological suspicion of pyelonephritis however the work-up for non-tuberculous infection (urine and blood cultures ) and urogenital tuberculosis was negative.

We attributed the renal papillary necrosis due to diabetes in the presence of further negative work-up for other causes.

Image courtesy: Dr Amaresh I. Ranchod