1. Possible left kidney infection (pyelonephritis)
2. Bladder inflammation / cystitis changes with irregular wall thickening (9 mm)
3. Enlarged prostate, about 38 cc, likely benign prostatic enlargement, which can cause incomplete bladder emptying and recurrent urine infection
4. Enlarged fatty liver (Grade II fatty liver)

Go to emergency care now if any of these are present

• Fever, chills/rigors, vomiting
• Left-sided back/flank pain
• Confusion, severe weakness, low blood pressure, fast breathing
• Reduced urine output, inability to pass urine, or severe lower-abdominal pain
• Very high glucose, ketones, or dehydration

What should be checked urgently

• Urine routine/microscopy and urine culture with antibiotic sensitivity
• Blood count, creatinine/eGFR, urea, electrolytes
• Blood glucose, HbA1c, and urine or blood ketones if glucose is high or he is ill
• Liver tests: AST, ALT, bilirubin, ALP, albumin
• Blood cultures if fever, chills, or suspected sepsis
• Post-void residual urine measurement, to see whether the enlarged prostate is retaining urine
• Urologist review: digital rectal examination and symptom assessment, often including PSA only after the infection/inflammation is treated, if clinically appropriate

Treatment approach

1. Treat possible kidney/bladder infection

• The doctor should start an antibiotic selected for a complicated UTI, then adjust it when the urine-culture result is available.
• The antibiotic choice, route, and duration depend on fever/severity, kidney function, previous cultures, antibiotic allergies, and local resistance patterns.
• Do not self-start leftover antibiotics.
• If fever, vomiting, sepsis, kidney impairment, or inability to take oral drugs is present, he may need hospital admission, IV fluids, IV antibiotics, and close glucose monitoring.
• Repeat clinical review in 48 to 72 hours is important. If not improving, culture should be reviewed and CT considered.

2. Address prostate enlargement and possible urinary retention

• If weak stream, straining, urgency, frequent night urination, incomplete emptying, or recurrent infection are present, a clinician may prescribe an alpha-blocker such as tamsulosin.
• If prostate enlargement is substantial and symptoms/risk of progression are high, a 5-alpha-reductase inhibitor may be considered by the urologist.
• If there is acute urinary retention, obstruction, recurrent infections, stones, kidney damage, or ongoing significant residual urine, catheterization and/or a urologic procedure may be needed.
• The infection should be treated first. Prostate-related obstruction can prevent full clearance of infection.

3. Control diabetes actively during infection

• Check capillary glucose more often, usually before meals and at bedtime while unwell.
• Maintain fluids unless a clinician has advised fluid restriction for heart or kidney disease.
• Do not stop insulin without medical advice. Insulin often needs temporary adjustment during infection.
• Review medicines if dehydrated, vomiting, or kidney function is impaired. A clinician may temporarily hold medicines such as metformin or SGLT2 inhibitors in selected sick-day situations.
• Obtain HbA1c and create a longer-term glucose plan after the acute infection settles.

4. Manage Grade II fatty liver / hepatomegaly

• Avoid alcohol until liver assessment is complete.
• Aim for gradual weight reduction if overweight. A target of roughly 7% to 10% weight loss can improve liver fat and inflammation.
• Mediterranean-style or high-fibre calorie-controlled eating pattern; avoid sugary drinks, refined carbohydrates, and excess saturated fat.
• Aim for at least 150 minutes/week of moderate physical activity, plus resistance exercise if able.
• Check blood pressure, lipid profile, HbA1c, and cardiovascular risk.
• Calculate FIB-4 from age, AST, ALT, and platelet count. In people with type 2 diabetes, repeat fibrosis-risk assessment every 1 to 2 years; an elevated or indeterminate result should lead to liver elastography and/or hepatology review, as advised by AASLD guidance.

Important follow-up point