Emphysematous pyelonephritis in a nonfunctional graft kidney:a case for early nephrectomy?
- Author:
Yeshwanth Mohan YELAVARTHY
1
;
Anish Kumar SAHA
;
Vinay RATHORE
;
Jyoti AGGARWAL
;
Shubham MAJUMDAR
;
Amit SHARMA
;
Sunil Kumar BEHERA
;
Sandeep DESAI
;
Rahul BHATIA
Author Information
- Publication Type:Case Report
- From: Clinical Transplantation and Research 2026;40(1):158-161
- CountryRepublic of Korea
- Language:English
- Abstract: Emphysematous pyelonephritis (EPN) is a severe necrotizing kidney infection characterized by gas formation. While EPN is recognized in native kidneys and occasionally in functional renal allografts, its occurrence in nonfunctional allografts is extremely rare.We present a case of EPN in a 38-year-old female with a history of renal transplantation who developed EPN in a nonfunctional graft 1 year after returning to hemodialysis.The patient initially demonstrated excellent graft function posttransplant but later developed chronic antibody-mediated rejection and calcineurin inhibitor toxicity, which led to graft failure and resumption of hemodialysis. One year later, she presented with fever and graft site tenderness. Imaging revealed stage 3 EPN in the allograft. Empirical broad-spectrum antibiotics and percutaneous drainage were initiated, followed by graft nephrectomy due to persistent fever spikes. This case highlights the occurrence of EPN in a nonfunctional graft, even after cessation of immunosuppression. The presence of a nonfunctioning graft with impaired blood supply may have provided a nidus for infection. It underscores the importance of considering nephrectomy as a primary therapeutic approach in such cases. This case also emphasizes the need for heightened clinical suspicion and prompt intervention in transplant recipients with suspected EPN, even in the absence of a functioning graft.
