MediAI

  Abstract Emphysematous pyelonephritis (EPN) represents a primary urological emergency characterized by necrotizing infection of the renal parenchyma and perirenal tissues, leading to the spontaneous accumulation of gas. Predominantly affecting patients with poorly controlled diabetes mellitus, EPN necessitates a multidisciplinary approach involving rapid radiologic identification, aggressive hemodynamic stabilization, and a combination of potent antimicrobial therapy and surgical intervention. This column explores the pathophysiology, imaging features, and evolving treatment algorithms for EPN, incorporating high-fidelity clinical cases and the latest evidence-based literature. I. Introduction Emphysematous pyelonephritis (EPN) is a rare but life-threatening, gas-forming, fulminant infection of the renal parenchyma and surrounding structures. Since its initial description in the late 19th century, EPN has remained a formidable challenge for clinicians due to its rapid progres...