Emphysematous pyelonephritis

Emphysematous pyelonephritis(EPN) is a potentially fatal manifestation of necrotizing infection of renal parenchymal tissues and perirenal tissues with gas formation in renal system. Its clinical significance due to its diagnostic difficulty on clinical grounds, rapid progression and the demand for the invasive management strategies in short term necessitates the need for a more vigilant approach in vulnerable population. Risk population includes female diabetic patients, obstructed infected urinary system, immunosuppression. Since its initial reporting from 19th century the treatment strategies are more towards extensive invasive approaches due to its rapid progression into fatal condition. Fortunately, with the advent of modern imaging facilities, the diagnostic difficulties were somewhat alleviated which helps in staging the disease. Thence the treatment strategy evolved over time which includes various options in treatment regime. Currently the treatment for emphysematous pyelonephritis includes resuscitation with fluid electrolyte management, intravenous antibiotics to cover gram negative bacteria, risk factor management, minimally invasive approaches towards decompression and in worst case scenario immediate or delayed nephrectomy. Here, we discuss the clinical features,aetiopathogenesis, diagnostic approaches and the treatment strategies of this uncommon but potentially fatal condition.