Successful nephrectomy after a failure of non-surgical treatment in emphysematous pyelonephritis: A case report

Emphysematous pyelonephritis (EP) is an uncommon condition involving acute severe necrotising infection in the renal parenchyma, perinephric space and collecting system, with a mortality rate of up to 13%. A 62-year-old male with poorly controlled diabetes mellitus presented with severe epigastric pain and shortness of breath for three days. A computed tomography scan revealed class 3B EP, which failed medical therapy and percutaneous drainage. He underwent a nephrectomy and achieved an excellent clinical recovery. Septic shock and uncontrolled diabetes mellitus are two risk factors that lead to a poorer prognosis. Class 3B EP with failed medical therapy and percutaneous drainage would benefit from nephrectomy.