Emphysematous pyelonephritis (EPN) is an uncommon necrotizing infection characterized by gas in the renal parenchyma and surrounding tissues. It is rapidly progressive and life endangering condition, requiring strong suspicion and appropriate therapy to salvage the infected kidney. We have delineated clinical, laboratory and imaging characteristics outcomes of patients with EPN admitted in hospital. Methodology: This prospective observational study was carried out in medicine wards of rural tertiary care hospital and medical college named DR. RPGMC Kangra at Tanda Himachal Pradesh. They presented with a clinical, laboratory and radiologic diagnosis of EPN. Each patient had a unique predisposing factor for developing EPN. Result: We studied 32 patients (mean age 48.6 years; females 71.87%). Risk factors for EPN were diabetes mellitus (in 93%) and renal stones (in 9%). Fever, loin pain, vomiting and dysuria were common. Complications included acute kidney injury, 74%; mostly stage 1, (77.5%), hyponatraemia (54%) and bacteraemia (28%). Escherichia coli was the most common (66%) urinary isolate. Most patients (78%) had class 2 EPN, with 12% class 3B and 10 % class 3A. Besides medical management, one (3.12%) required surgery (nephrectomy). Nephrectomised patient had a higher radiological class and one death occurred. Early goal directed therapy with intravenous fluids and antibiotics was given. This was followed by less invasive urologic interventions in an attempt to avoid nephrectomy and thereby salvage the infected kidney. Out of 32 patients, 30 patients were discharged in clinically stable conditions. One patient was referred to higher centre PGIMER Chandigarh for further management. Where he was managed conservatively initially, but condition kept on deteriorating, subsequently nephrectomy was done and he was discharged after 21 days of admission on oral antibiotics. Discussion and Conclusion: This study provides practice-based support to available literature for managing EPN. Early goal directed medical therapy for sepsis coupled with interventional urologic procedures is a useful alternative to avoid forthcoming emergent nephrectomy except in cases where a fulminant infection may be present at the time of admission or develop later on in the course of the illness despite conservative line of therapy. It also high points the importance of considering a diagnosis of EPN in patients with urinary infections who have certain predisposing factors like diabetes mellitus.

Emphysematous pyelonephritis (EPN) is an uncommon necrotizing infection characterized by gas in the renal parenchyma and surrounding tissues. It is rapidly progressive and life endangering condition, requiring strong suspicion and appropriate therapy to salvage the infected kidney. We have delineated clinical, laboratory and imaging characteristics outcomes of patients with EPN admitted in hospital. Methodology: This prospective observational study was carried out in medicine wards of rural tertiary care hospital and medical college named DR. RPGMC Kangra at Tanda Himachal Pradesh. They presented with a clinical, laboratory and radiologic diagnosis of EPN. Each patient had a unique predisposing factor for developing EPN. Result: We studied 32 patients (mean age 48.6 years; females 71.87%). Risk factors for EPN were diabetes mellitus (in 93%) and renal stones (in 9%). Fever, loin pain, vomiting and dysuria were common. Complications included acute kidney injury, 74%; mostly stage 1, (77.5%), hyponatraemia (54%) and bacteraemia (28%). Escherichia coli was the most common (66%) urinary isolate. Most patients (78%) had class 2 EPN, with 12% class 3B and 10 % class 3A. Besides medical management, one (3.12%) required surgery (nephrectomy). Nephrectomised patient had a higher radiological class and one death occurred. Early goal directed therapy with intravenous fluids and antibiotics was given. This was followed by less invasive urologic interventions in an attempt to avoid nephrectomy and thereby salvage the infected kidney. Out of 32 patients, 30 patients were discharged in clinically stable conditions. One patient was referred to higher centre PGIMER Chandigarh for further management. Where he was managed conservatively initially, but condition kept on deteriorating, subsequently nephrectomy was done and he was discharged after 21 days of admission on oral antibiotics. Discussion and Conclusion: This study provides practice-based support to available literature for managing EPN. Early goal directed medical therapy for sepsis coupled with interventional urologic procedures is a useful alternative to avoid forthcoming emergent nephrectomy except in cases where a fulminant infection may be present at the time of admission or develop later on in the course of the illness despite conservative line of therapy. It also high points the importance of considering a diagnosis of EPN in patients with urinary infections who have certain predisposing factors like diabetes mellitus.