Q: 32 year old diabetic female is admitted with fever, chills, abdominal pain, nausea, vomiting, left flank pain with crepitation over left flank and urinary symptoms. What's your concern?

Answer: Emphysematous pyelonephritis

Emphysematous pyelonephritis is a necrotizing acute nephritis with extension of the infection through the renal capsule. This leads to the presence of gas within the kidney and in the perinephric space.

The mortality rate is 60% - 80% despite medical treatment and usually require surgical intervention with nephrectomy.