Emphysematous Pyelonephritis: When Minimally Invasive Approaches are not Enough

The author presents a case of a diabetic patient that developed a severe left emphysematous pyelonephritis manifested by septic shock that was managed initially with minimally invasive techniques with percutaneous drainage and wide-spectrum antibiotics. Besides her clinical improvement the gas wasn’t resolved entirely even after a second percutaneous drainage and eventually ended in a simple nephrectomy due to persistent fever. What would seem like a pretty common management for this clinical entity, nowadays it represents the exception rather than the rule. This case exemplifies how even though the minimally invasive approaches are used to spare the kidney, a nephrectomy still plays a role in the management of patients with this complicated infection.