Medical Therapy in Emphysematous Pyelonephritis

Emphysematous pyelonephritis is a necrotizing infection of the renal parenchyma, which has been traditionally treated with surgical management. Emphysematous pyelonephritis presents clinically with varying degrees of renal failure, delirium, metabolic acidosis, septic shock, and hyperglycemia. Computed tomography is needed in most cases for diagnosis and staging of the disease. We report a case of emphysematous pyelonephritis successfully treated medically with the institution of early goal-directed therapy with only antibiotics and activated protein C, without the need for even percutaneous drainage.