A 56 year-old Caucasian female who has a history of recurrent pyelonephritis, obstructive uropathy and stage 4 chronic kidney disease initially presented to the infectious disease team with bacterial endocarditis. A CT demonstrated bilateral renal obstruction: right secondary to two 4-mm distal ureteric stones, and left secondary to long -standing pelviure-teric junction (fig. 1). The patient developed urosepsis, and bilateral nephrostomies were inserted to decompress the kidneys.