INTRODUCTION: Emphysematous pyelonephritis (EPN) is an acute necrotizing infection of renal parenchyma. We discuss clinical details and treatment modalities of 45 patients with EPN followed at our hospital. EPN is common in persons with uncontrolled diabetes, often has a fulminating course and can be fatal if not recognized and treated promptly. Its overall mortality rate ranges between 19% and 43%.3 METHODS: We retrospectively reviewed the clinical, laboratory, radiological findings and treatment modalities of 45 patients with EPN followed at our hospital between 2014 and 2018. RESULTS: A total of 45 patients were included in our study. Mean age of the patients was 59 years with age range of 42 – 80 years. Out of 45 cases 42 patients were a known case of type 2 diabetes. All patients were initially managed by strict diabetic control, fluid and electrolyte correction and IV antibiotics. Nephrostomy tube was placed in 13 patients and nephrectomy was done in 4 patients. 4 patients died post operatively. At 6 months follow up patients with class I and class II had creatinine levels within normal range. Patients who underwent nephrostomy in class III A and Class III B creatinine levels ranged between 1.8 to 2.3 mg/dl. CONCLUSION: Mortality rates of EPN are gradually decreasing all over the world. Preservation of renal parenchyma is possible due to early diagnosis, appropriate antibiotic therapy, and drainage.