LAUSR

A 66- year-old woman with a 5-year history of diabetes presented with right lumbar pain and a 1-day fever of 39°C, unresponsive to over- the-counter antipyretics. Clinical examination revealed tenderness in the right lumbar region and positive renal percussion. She was alert and oriented, with a heart rate of 84 bpm, blood pressure of 140/100 mmHg, temperature of 39°C, and SpO2 of 95% (room air). Initial laboratory results showed a white blood cell count of 38 K/uL (88% neutrophils). Liver and renal function tests and coagulation profiles were normal. Computed tomography (CT) revealed grade IV right kidney hydronephrosis with gas formation, suggesting grade IIIA emphysematous py-elonephritis (EPN) and right renal calculi (Figure 1). Emergency intervention involved percutaneous drainage and placement of two Mono J stents under ultrasound guidance, draining 1200 mL of brown fluid with significant gas release (Figure 2). The patient was