Conservative Management of Emphysematous Pyelonephritis with Obstructive Renal Calculus in a Diabetic Female: A Case Report

Emphysematous pyelonephritis (EPN) is a rare, life-threatening narcotising renal infection characterised by gas formation within the renal parenchyma, collecting system, or perinephric tissues. It commonly occurs in patients with diabetes mellitus and urinary tract obstruction. Early diagnosis and timely management are critical to reduce morbidity and mortality. We report the case of a 45-year-old diabetic female who presented with left flank pain, fever, and dysuria of 7-10 days duration. Imaging revealed obstructive left renal pelvic calculus with features of emphysematous pyelonephritis. She was managed initially with broad-spectrum intravenous antibiotics followed by left-sided DJ stenting. Significant clinical, biochemical, and radiological improvement was seen, avoiding emergency nephrectomy.