Objective: A prospective observational study was conducted at Department of  General Surgery at RML institute of Medical sciences , Lucknow  as well   as at Eras Lucknow medical college , Lucknow from 2015-2018 to look for clinical, microbial profile and treatment outcome of diabetic patients with emphysematous pyelonephritis Methods: 76 Diabetic patients diagnosed with pyelonephritis were identified, of which 15 patients were diagnosed with EPN (26.3%). Mean duration of diabetes was 5.3 ± 3.3 years. 82% patients had a glycosylated hemoglobin A1C level > 7.5. Renal dysfunction at presentation was seen in 73.3%. Escherichia coli in 11 (73.3%), Klebsiella sp. in 1 (6.6%), Pseudomonas in 1 (6.6%), and 1 each with polymicrobial and fungal UTI respectively.  Of 15 EPN patients, 13 (86.6 %) survived and 1 (6.6 %) expired.  2 of them underwent nephrectomy both survived. All patients with Stage I, II and IIIa EPN (n = 12) were managed with antibiotics with or without PCD. In EPN Stage IIIb/IV (n = 3), all the 3 (20 %) patients were managed with antibiotics and PCD and later 2 (13.3%) needed nephrectomy. Only time to diagnosis, altered sensorium, shock at presentation and thrombocytopenia were associated with poor outcome in EPN patients (P < 0.05) Multiple logistic regression tests showed shock (P = .04) and and disturbance of consciousness (P = .05) on hospital admission as being the independent factors for poor outcome.   Results: EPN in diabetics needs high index of suspicion, timely diagnosis and good multidisciplinary approach with adequate antibiotics and surgical management for better patient outcomes Conclusions: Objective: Emphysematous pyelonephritis (EPN) is a rare but life-threatening acute suppurative infection of the kidney among diabetics. There is no current consensus on management of EPN .   Methods: A prospective observational study was conducted at Department of  General Surgery at RML institute of Medical sciences , Lucknow  as well   as at Eras Lucknow medical college , Lucknow from 2015-2018 to look for clinical, microbial profile and treatment outcome of diabetic patients with emphysematous pyelonephritis Results: 76 Diabetic patients diagnosed with pyelonephritis were identified, of which 15 patients were diagnosed with EPN (26.3%). Mean duration of diabetes was 5.3 ± 3.3 years. 82% patients had a glycosylated hemoglobin A1C level > 7.5. Renal dysfunction at presentation was seen in 73.3%. Escherichia coli in 11 (73.3%), Klebsiella sp. in 1 (6.6%), Pseudomonas in 1 (6.6%), and 1 each with polymicrobial and fungal UTI respectively.  Of 15 EPN patients, 13 (86.6 %) survived and 1 (6.6 %) expired.  2 of them underwent nephrectomy both survived. All patients with Stage I, II and IIIa EPN (n = 12) were managed with antibiotics with or without PCD. In EPN Stage IIIb/IV (n = 3), all the 3 (20 %) patients were managed with antibiotics and PCD and later 2 (13.3%) needed nephrectomy. Only time to diagnosis, altered sensorium, shock at presentation and thrombocytopenia were associated with poor outcome in EPN patients (P < 0.05) Multiple logistic regression tests showed shock (P = .04) and and disturbance of consciousness (P = .05) on hospital admission as being the independent factors for poor outcome.   Conclusions: EPN in diabetics needs high index of suspicion, timely diagnosis and good multidisciplinary approach with adequate antibiotics and surgical management for better patient outcomes