Successful medical treatment of acute bilateral emphysematous pyelonephritis

Am J Kidney Dis. 2000 Dec;36(6):1267-70. doi: 10.1053/ajkd.2000.19844.


Emphysematous pyelonephritis most often presents as an acute medical emergency, typically in a septic diabetic patient with acute renal failure. The management of this condition has traditionally been surgical, with nephrectomy. However, some recent reports have described successful medical interventions. We describe a case of acute bilateral emphysematous pyelonephritis in a frail patient not suitable for bilateral nephrectomy and long-term dialysis. This condition was managed medically, not surgically, with intensive antibiotic and circulatory support. The outcome was complete recovery after months of hospital-based treatment. We discuss the management of this rare but important condition in detail.

Publication types

  • Case Reports

MeSH terms

  • Acute Kidney Injury / therapy*
  • Anti-Bacterial Agents / therapeutic use*
  • Combined Modality Therapy
  • Diabetes Mellitus, Type 2 / complications
  • Emphysema / therapy*
  • Hemofiltration*
  • Humans
  • Male
  • Meropenem
  • Middle Aged
  • Pyelonephritis / therapy*
  • Sepsis / complications
  • Sepsis / drug therapy
  • Thienamycins / therapeutic use*
  • Treatment Outcome
  • Vancomycin / therapeutic use*


  • Anti-Bacterial Agents
  • Thienamycins
  • Vancomycin
  • Meropenem