A RARE CASE OF ACUTE PYELONEPHRITIS LEADING TO ACUTE KIDNEY INJURY IN A YOUNG MALE

A 16-year-old male presented with severe shortness of breath, fever with chills, and decreased urine output for four days. On examination, oxygen saturation was 84% on room air, blood pressure 140/90 mmHg, and heart rate 114/min. Respiratory system examination revealed bilateral coarse crepitations. Laboratory investigations showed markedly elevated blood urea (256 mg/dL) and creatinine (13.56 mg/dL) with metabolic acidosis (pH 7.27, bicarbonate 12.2mmol/L). Ultrasonography demonstrated bilateral swollen kidneys, and NCCT KUB confirmed acute pyelonephritis. The patient was managed with intravenous broad-spectrum antibiotics and haemodialysis in view of severe uraemia, acidosis, and volume overload. Over the following week, renal function and urine output improved significantly, and dialysis was discontinued. Subsequent evaluation revealed an HbA1c of 8.0%, indicating previously undiagnosed diabetes mellitus as an underlying predisposing factor. The patient was discharged on the 8th day in stable condition. This case underscores that acute pyelonephritis with acute kidney injury can be the first manifestation of undiagnosed diabetes mellitus, even in adolescents, and highlights the importance of early recognition, prompt antibiotic therapy, and renal support for favourable outcomes.