Objectives To investigate plasma and urinary kynurenine (KYN)–tryptophan (TRP) ratios in bladder cancer, expression of indoleamine 2,3‐dioxygenase 1 (IDO1) in relation to tryptophan 2,3‐dioxygenase (TDO2) in bladder tumour, and the correlation of KYN–TRP ratio with bladder tumour burden. Methods Metabotyping of the TRP–KYN metabolic axis was performed via a clinical case–control study. Expression of IDO1 and TDO2 was measured in human biopsied tissues. Correlational experiments between KYN–TRP ratio and bladder tumour were performed using a murine orthotopic prostate‐specific antigen (PSA)‐secreting MB49 bladder cancer model. Results We established for the first time that plasma TRP level was significantly decreased, while both plasma and urinary KYN–TRP ratios were significantly higher in bladder cancer patients, and expression level of IDO1 but not TDO2 was increased in human bladder tumour. We reported the positive correlation between IDO1 expression, KYN–TRP ratio, normalized PSA to creatinine, and bladder tumour burden in the murine model. Conclusion Kynurenine–tryptophan ratio is a promising surveillance biomarker for bladder cancer, but would require further validation before clinical translation.

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Background: Emphysematous pyelonephritis (EPN) is a severe, necrotizing infection of the renal parenchyma. Until the late 1960s, these patients were treated with nephrectomies as EPN is associated with a high rate of mortality. It is a diagnosis based on computed tomography (CT) scan of the patient and based on the results, can be classified according to the severity of the disease. In our case report, we present a patient with seemingly extensive EPN on CT scan who was treated successfully with intravenous antibiotics (IV) and percutaneous drainage. Methods: Together with current literature, our case study adds to increasing evidence which supports how carefully selected patients can be treated with the above modalities.Results: We present a 75-year-old diabetic Indian gentleman who came to us with right iliac fossa pain and was noted to have a positive right renal punch. CT scan revealed extensive gas in the right kidney. Considering that he was clinically stable amongst other factors, he was started on appropriate IV antibiotics and underwent a percutaneous nephrostomy tube insertion. Subsequent follow-up scans showed resolution of the EPN. Conclusions: EPN is a severe, necrotizing infection of the kidneys associated with high mortality rates. As such, physicians need to have a high index of suspicion in patients who are at risk. There is increasing evidence to show that patients with early EPN can and should be treated with appropriate IV antibiotics and percutaneous drainage procedures. We hope that this will help to increase awareness of the possible treatment modalities of this potentially life-threatening disease.