Emphysematous pyelonephritis (EPN) is a life threatening necrotizing infection of the kidney. It is commonly seen in diabetic patients and continuous to be a major cause for morbidity Treatment options were limited in the past and most patients were managed surgically. With newer antibiotic protocols medical management is effective in most of the cases. Aims and Objectives: To study about the mortality with conservative medical management of Emphysematous Pyelonephritis in type 2 Diabetes Mellitus patients. Methods: Study population included type 2 Diabetes Mellitus patients with urinary tract infection (UTI) (proven by culture) and radiological evidence of Gas in the collecting system, renal parenchyma or perirenal tissue. 50 patients with EPN who were admitted in our hospital from1 October, 2010 to March 31, 2021 were included in this prospective observational study. The clinical presentation, comorbidities, baseline laboratories data and abdominal CT scan were taken. Patients were classified into four stages based on CT imaging. All the patients were started on medical management with antibiotics. Those patients not responded to medical therapy were offered surgical treatment and the outcome of management was assessed. Results: Mean age of the study group was 59.24 years. Fever was the most common presenting symptom (100%). E.Coli was the most common organism isolated from urine (75%). Patients were divided into different classes based on CT imaging and most of them belonged to class II (50%). Most of the patients managed successfully with antibiotics. Multiple factors found to influence the mortality such as shock, altered sensorium and advanced classes in CT scan. Conclusions: Medical therapy is the corner stone of management of class I and class II EPN. Keywords: Emphysematous Pyelonephritis; Type 2 Diabetes Mellitus.