Introduction: Emphysematous pyelonephritis (EPN) is defined as an acute, severe necrotizing infection of the renal parenchyma and peri-renal tissue, which results in the presence of gas within the renal parenchyma, collecting system or perinephric tissue. EPN is a rare, life-threatening condition. Traditionally, immediate nephrectomy was the treatment of choice for such cases which posed high mortality rate (up to 40%). Recently, the mortality rates are reducing because of improved staging modalities due to better imaging modalities and effective antibiotics, percutaneous catheter drainage, double J stenting.
Case Report: A 63-year-old female, known case of ischemic heart disease, hypertension and long standing diabetes mellitus type II on insulin presented with picture suggestive of extensive emphysematous pyelonephritis. Due to her comorbidities and high risk for any anesthesia or major surgical intervention, we opted to treat patient conservatively with hydration, IV fluids, antibiotics and percutaneous nephrostomy drainage. Patient had a very successful course and she was fully recovered with conservative therapy.
Conclusion: Minimal invasive technique like percutaneous nephrostomy drainage can be considered as a safe and valid modality of treating selected patients with extensive emphysematous pyelonephritis thus reducing risk of mortality and major alternative procedures.

Keywords: Conservative, Emphysematous Pyelonephritis, Kidney, Percutaneous nephrostomy