Emphysematous pyelonephritis in a nonfunctional graft kidney: a case for early nephrectomy?
Year: 2026
Type: article
Study design: Case Report
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.
DOI: 10.4285/ctr.25.0031
Authors: Yeshwanth Mohan Yelavarthy, Anish Kumar Saha, Vinay Rathore, Jyoti Aggarwal, Shubham Majumdar, Amit Sharma, Sunil Kumar Behera, Sandeep Desai, Rahul Bhatia
Institution: All India Institute of Medical Sciences Raipur
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7125228495
FWCI:
Cites:
Cited by:
Related to: