Extensive emphysematous pyelonephritis in a renal allograft treated conservatively: case report and review of the literature

Transpl Infect Dis. 2012 Dec;14(6):E150-5. doi: 10.1111/tid.12016. Epub 2012 Oct 1.


Emphysematous pyelonephritis (EPN) is a rare occurrence in renal allografts. An aggressive approach resulting in transplant nephrectomy is viewed as the standard of care. Over the recent years, treatment with percutaneous drainage (PCD) of the renal and perinephric collections and appropriate antibiotics has been reported with good success in lesser grades of this infection. Only 4 cases of extensive EPN disease with Escherichia coli, treated with conservative management, are reported in the English-language literature. We present a case of severe EPN caused by Klebsiella pneumoniae, successfully managed with early PCD, and propose a step-up strategy aimed toward graft preservation.

Publication types

  • Case Reports

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Drainage
  • Drug Resistance, Multiple, Bacterial
  • Female
  • Humans
  • Immunocompromised Host
  • Kidney Transplantation / adverse effects*
  • Klebsiella Infections / drug therapy
  • Klebsiella Infections / etiology
  • Klebsiella pneumoniae / drug effects
  • Klebsiella pneumoniae / isolation & purification
  • Middle Aged
  • Pyelonephritis / drug therapy*
  • Pyelonephritis / etiology*
  • Pyelonephritis / surgery


  • Anti-Bacterial Agents