Background:Inflammation of renal parenchyma and collecting system are usually secondary to microbial infections.Course of the renal inflammation depends on the pathogenic virulence factors, predisposing co morbid illness and conditions in the host, severity of the infectious process, the time of presentation, and the effectiveness of therapy instituted.This study is intended to analyse the various factors that can influence the course and alter the outcome of the inflammatory pathologies of the kidney.Methods:Prospective  clinical study conducted in 30 patients with features of acute  renal inflammation at Tirunelveli Medical College Hospital , Tirunelveli.The risk factors, Clinical manifestations, Laboratory Investigations , Imaging Studies, Therapeutic interventions , Final outcome , Follow up were recorded and analysed with Statistical Package for the Social Sciences (SPSSP Version 15) software using Pearson’s Chi–Square Test    and Fisher’s Exact Test with P < 0.05 considered to indicate statistical significanceResults:The predominant risk factor for complicated renal infections in our study was the presence of diabetes. The presence of an altered mental status at presentation, poor glycemic control ( increased HbAlc levels ) , increased serum creatinine , thrombocytopenia and presence of hydronephrosis at presentation are  associated  with  higher  need  for  nephrectomy  in  our  study. Type of renal lesion at presentation significantly influencesthe  therapeuticoption excised and the need for performing nephrectomy