Emphysematous pyelonephritis (EPN) is a necrotizing renal parenchymal infection with production of intraparenchymal gas. EPN predominantly affects female, diabetics, obstructive uropathy, debilitating alcoholism and immunocompromised person. The best tool of diagnosis is computed tomography which also indicates further therapeutic strategies. The major treatments are conservative medical treatment, percutaneous drainage, or nephrectomy, which has differential advantages. We review the new published points over the last two decades and suggest appropriate procedures to provide the better outcome.