Conservative Management of Emphysematous Pyelonephritis in Transplantation

Emphysematous pyelonephritis is a urologic emergency condition characterized by an acute and severe necrotizing parenchymal and perirenal infection caused by Gas-forming uropathogens. predisposing factors include diabetes,immunosuppression conditions, urinary tract obstruction associated with urinary calculi or papillary necrosis and significant renal functional impairment. The overall mortality rate has been reported to be between19%to 43% and few cases in kidney allograft have been reported. All of the documented cases of emphysematous pyelonephritis have occurred in adults Juvenile diabetic patients do not appear to be at risk. Female are affected more often than male.we report A 66-year-old diabetic man with ESRD (end stage renal disease) received deceased renal transplant two mounts after transplantation admitted in hospital , with complain of reduced urine out-put an increase in serum creatinine (Cr) level,fever and abdominal pain.. The patient was treated with 250 mg intravenous imipenem q12h and 1 g intravenous vancomycin and patient take under hemodialysis every other day for one week, An ultrasound guided percutaneous nephrostomy accomplished and fortunately he did considerably respond clinically and radiologically the transplanted kidney was saved.