A 42-year-old man presents to the emergency department with complaints of severe flank pain, haematuria, and dysuria. He has a history of poorly controlled diabetes mellitus and hypertension. Over the past month, he has experienced increasing episodes of abdominal pain and has noticed blood in his urine intermittently. He also reports frequent urination and an urgent need to urinate at night.

On examination, he is afebrile but appears anxious and is tender in both flanks. Laboratory tests show an elevated serum creatinine level of 1.8 mg/dL, and urinalysis reveals significant haematuria and pyuria. A CT scan of the abdomen with contrast is performed, which reveals characteristic changes consistent with renal papillary necrosis, including the presence of necrotic renal papillae.

The patient is diagnosed with renal papillary necrosis, likely secondary to his longstanding diabetes and associated conditions. He is started on supportive care, including pain management and hydration, and is referred to a nephrologist for further management of his diabetes and to prevent further renal deterioration. The patient is advised on lifestyle modifications and the importance of strict glycaemic control to reduce the risk of future renal complications. Follow-up appointments are scheduled to monitor his kidney function and manage his diabetes.