Emphysematous pyelonephritis.

A case of emphysematous pyelonephritis with perirenal gas is presented. This patient underwent vigorous medical treatment followed by nephrectomy and survived. This condition has a high mortality and should be distinguished from less severe infections where gas is confined to the collecting system. This case and others previously reported suggest that treatment should initially be medical, followed by early surgical intervention consisting of either drainage or nephrectomy depending upon the degree of renal involvement.