Emphysematous pyelonephritis (EPN) has a high rate of mortality due to sepsis as a complication of EPN, and majority of patients have a good outcome with a minimally invasive approach such as medical management by antibiotics and supportive care. Studies show that early nephrectomy should be reserved for those who do not respond to initial conservative management once the patient is stabilized. Decisions of management should take into account the patient's current renal function which can be

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... ermined by looking at serum creatinine level or eGFR as to whether nephrectomy, percutaneous drainage or antibiotics would be most appropriate bearing in mind that a minimal approach of antibiotics alone has a higher risk of mortality compared with additional percutaneous drainage of abscess or nephrectomy. Although regarding this case, the patient had a background of congenital renal disease namely her medullary sponge kidney in addition to the formation of matrix stone which increased the severity of her already class IV EPN, conventional treatment via antibiotics was unsuccessful and so was nephrostomy drainage. Therefore unconventional method of percutaneous nephrolithotomy (PCNL) was adopted to treat her bilateral disease and this was successful as evident on the scans.