# Severe emphysematous pyelonephritis managed with staged percutaneous drainage – A Changing paradigm

## TL;DR

A severe kidney infection with gas was successfully treated using multiple minimally invasive drainage procedures in a diabetic patient.

## Contribution

Demonstrates the effectiveness of staged percutaneous drainage in severe EPN cases.

## Key findings

- Staged percutaneous drainage successfully managed a severe Class IIIb EPN case.
- Clinical, biochemical, and radiological assessments guided treatment decisions.
- Minimally invasive approach avoided the need for open surgery or nephrectomy.

## Abstract

Emphysematous pyelonephritis (EPN) is a potentially life-threatening infection of the renal parenchyma and perinephric tissues by gas-forming organisms. Historically, open surgical drainage or nephrectomy was the standard of care, however, in recent years percutaneous drainage as a minimally invasive approach has become popular. However, whether percutaneous drainage can be successful in more severe cases of EPN is less clear. We report a case of severe Class IIIb EPN managed successfully with multiple staged percutaneous drainage procedures guided by interval re-assessment of clinical, biochemical, and radiological progress in a 52-year-old male with poorly controlled Type 2 Diabetes.