A 31-year-old woman without any prior disease presented to the emergency department complaining of progressive distention of the abdomen for 10 days. Her medical history was unremarkable, and she was not on any medication. The patient stated she had difficulty urinating for the past 7 days. Physical examination revealed a large palpable mass in the abdomen. Laboratory studies revealed the following: serum glucose 807 mg/dL, glycated hemoglobin 14.7% without evidence of ketoacidosis, blood urea nitrogen 104.3 mg/dL, creatinine 8.47 mg/dL, corrected sodium 128 mEq/L, potassium 4.8 mEq/L, urine creatinine 23.8 mg/dL, and urine sodium 38 mEq/L. Her fasting and postprandial C-peptide levels were 1.27 and 3.58 ng/mL, respectively, suggestive of first diagnosed type 2 diabetes. The calculated fractional excretion of sodium was 10.1%, highly suggestive of post-renal acute renal failure. Abdomen and pelvis computed tomography revealed a marked distended bladder (Fig. 1A) with bilateral hydronephrosis and hydroureters (Fig. 1B). A Foley catheter was inserted initially presenting 3,500 mL of urine. Three days after Foley insertion, the serum creatinine level fell under 1.0 mg/dL. However, the patient failed to remove the Foley catheter despite the use of anticholinergics. One month later, renal microabscess with papillary necrosis developed in both kidneys (Fig. 2). Even with intensive antibiotics and glucose management, the patient experienced kidney failure and thus hemodialysis treatment was initiated.