Emphysematous Pyelonephritis in a Renal Transplant Patient


Emphysematous pyelonephritis (EPN) is a necrotizing bacterial infection of the kidney that is caused by gas-forming organisms. We report a case of a 58-year-old man with a renal transplant who presented to the emergency room with nausea, vomiting and right lower quadrant abdominal pain. At the time of presentation, he was hemodynamically stable, and the abdominal examination was significant for tenderness over the allograft. Urinalysis was positive for large amounts of leukocyte esterase and white blood cells. He received empiric antibiotic coverage with piperacillin/tazobactam. Over the following 24 hours, the patient developed septic shock manifested by hemodynamic instability. A non-contrast CT scan of the abdomen and pelvis elucidated a heterogeneous gas containing collection in the allograft. Emergent transplant nephrectomy was performed. Postoperatively, the patient rapidly recovered and was subsequently discharged home to commence outpatient hemodialysis. A review of the literature suggests that early recognition of the severity of EPN as manifested by hemodynamic instability dictates emergent transplant nephrectomy as the treatment of choice.

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Piracha, K. , Darras, F. , Nord, E. and Wadhwa, N. (2014) Emphysematous Pyelonephritis in a Renal Transplant Patient. Open Journal of Nephrology, 4, 86-91. doi: 10.4236/ojneph.2014.42012.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Alexander, S., et al. (2012) Extensive Emphysematous Pyelonephritis in a Renal Allograft Treated Conservatively: Case Report and Review of the Literature. Transplant Infectious Disease, 14, E150-E155.
[2] Baliga, K.V., et al. (2007) Successful Medical Treatment of Emphysematous Pyelonephritis in a Renal Allograft Recipient. Renal Failure, 29, 755-758.
[3] Schmidt, S., et al. (2009) Emphysematous Pyelonephritis in a Kidney Allograft. American Journal of Kidney Diseases, 53, 895-897.
[4] Huang, J.J. and C.C. Tseng (2000) Emphysematous Pyelonephritis: Clinicoradiological Classification, Management, Prognosis, and Pathogenesis. Archives of Internal Medicine, 160, 797-805.
[5] Wan, Y.L., et al. (1996) Acute Gas-Producing Bacterial Renal Infection: Correlation between Imaging Findings and Clinical Outcome. Radiology, 198, 433-438.
[6] Al-Geizawi, S.M., et al. (2010) Renal Allograft Failure Due to Emphysematous Pyelonephritis: Successful Non-Operative Management and Proposed New Classification Scheme Based on Literature Review. Transplant Infectious Disease, 12, 543-550.
[7] Vivek, V., Panda, A. and Devasia, A. (2012) Emphysematous Pyelonephritis in a Renal Transplant Recipient―Is It Possible to Salvage the Graft? Annals of Transplantation, 17, 138-141.
[8] Baas, M.C., van Donselaar, K.A., van der Pant and Bemelman, F.J. (2009) Emphysematous Pyelonephritis in a Renal Transplant Patient. The Netherlands Journal of Medicine, 67, 403-404.
[9] Parameswaran, R. and Feest, T. (1977) Gas Nephrogram: An Unusual Complication of Renal Transplantation. British Journal of Radiology, 50, 438-440.
[10] Brenbridge, A.N., et al. (1979) Renal Emphysema of the Tranplanted Kidney: Sonographic Appearance. (AJR) American Journal of Roentgenology, 132, 656-658.
[11] Balsara, V.J., Raval, B. and Maklad, N.F. (1985) Emphysematous Pyelonephritis in a Renal Transplant: Sonographic and Computed Tomographic Features. Journal of Ultrasound in Medicine, 4, 97-99.
[12] Potter, J.L., et al. (1985) Emphysema in the Renal Allograft. Radiology, 155, 51-52.
[13] O’Donnell, D., Rumbak, M. and Anderson, J. (1986) Emphysematous Pyelonephritis in a Transplanted Kidney. Clinical Nephrology, 25, 52-53.
[14] Glen, D., Bayliss, A.P. and Robertson, E.M. (1989) Percutaneous Drainage in Emphysematous Pyelonephritis. Clinical Radiology, 40, 434.
[15] Kalra, O.P., et al. (1993) Emphysematous Pyelonephritis and Cystitis in a Renal Transplant Recipient—Computed Tomographic Appearance. The International Journal of Artificial Organs, 16, 41-44.
[16] Akalin, E., et al. (1996) Emphysematous Cystitis and Pyelitis in a Diabetic Renal Transplant Recipient. Transplantation, 62, 1024-1026.
[17] Cheng, Y.T., Wang, H.P. and Hsieh, H.H. (2001) Emphysematous Pyelonephritis in a Renal Allograft: Successful Treatment with Percutaneous Drainage and Nephrostomy. Clinical Transplant, 15, 364-367.
[18] Iqubal, M., et al. (2004) Abdominal Gas Is Not Always Bowel Associated: Lessons from an Allograft Recipient. Nephrology Dialysis Transplantation, 19, 503-504.
[19] Al-Makadma, A.S. and Al-Akash, S.I. (2005) An Unusual Case of Pyelonephritis in a Pediatric Renal Transplant Recipient. Pediatric Transplantation, 9, 258-260.
[20] Fujita, S., et al. (2005) Case of Emphysematous Pyelonephritis in a Renal Allograft. Clinical Transplant, 19, 559-562.
[21] Arai, S., et al. (2006) A Case of Emphysematous Pyelonephritis in a Renal Allograft. Transplantation, 81, 296-297.
[22] Chuang, Y.W., et al. (2007) Severe Emphysematous Pyelonephritis in a Renal Allograft: Successful Treatment with Percutaneous Drainage and Antibiotics. Clinical Nephrology, 68, 42-46.
[23] Boltan, L.E., Randall, H. and Barri, Y.M. (2008) Iatrogenic Emphysematous Pyelonephritis in a Renal Transplant Patient. Transplant Infectious Disease, 10, 409-412.

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