A 45-year-old man presents to the clinic with complaints of recurrent flank pain, fatigue, and episodes of fever over the past several months. He has a history of recurrent urinary tract infections (UTIs) and was treated for acute pyelonephritis twice in the last year. He reports increased urinary frequency and occasional dysuria but has not sought treatment for these symptoms until now.

On examination, he is mildly hypertensive with a blood pressure of 150/95 mmHg, and there is tenderness in both flanks. Laboratory tests show a slightly elevated serum creatinine level of 1.5 mg/dL and a urinalysis that reveals persistent proteinuria and bacteriuria, along with white blood cells and occasional casts. A renal ultrasound shows scarring in both kidneys and a reduction in renal size, indicating chronic changes.

The patient is diagnosed with chronic pyelonephritis, likely due to longstanding untreated urinary infections and possible anatomical abnormalities contributing to his recurrent UTIs. He is started on a long-term course of antibiotics and referred for further evaluation of his urinary tract to identify any underlying issues. Lifestyle modifications, including increased hydration and regular follow-up, are also recommended to monitor kidney function and manage his hypertension.