Emphysematous pyelonephritis with calculus: Management strategies

OBJECTIVE: Emphysematous pyelonephritis (EPN) with calculus is well recognized but with very few reports on its treatment. Our aim is to elucidate our experience in its successful management. MATERIALS AND METHODS: Over four years, we diagnosed seven cases (eight renal units) of EPN, out of which two patients (three renal units) had EPN with urinary calculi. After the initial conservative management of EPN, the stones were tackled appropriately. RESULTS: EPN was initially managed effectively with antibiotics and supportive care. Once the patient was stable, the stones were cleared in a step-wise fashion. The associated postoperative complications were also tackled efficiently with preservation of renal function. CONCLUSION: In EPN with stones, nephrectomy is not the sole option available and they can be effectively managed with open / endoscopic measures.