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Emphysematous Pyelonephritis (EP) is a rare necrotizing renal parenchymal infection characterised by gas within the kidney parenchyma. Management with emergency nephrectomy has transitioned to a graded medical, radiological intervention and surgical approach. We present a rare case of high-risk emphysematous pyelonephritis, outlining key high risk factors and demonstrating staggered care escalation within a rural Australian referral hospital.