The author reports the case of a well and fit patient who presented herself to the emergency department and was found to have bilateral emphysematous pyelonephritis. She was admitted to the intensive care where she was initially treated conservatively with antibiotics, percutaneous drainage and continuous renal replacement therapy, but her condition deteriorated. She underwent a left total nephrectomy and a partial right nephrectomy that resulted in remarkable improvement. The patient started passing urine spontaneously, so no haemofiltration was required. She was discharged home and her case was followed-up by an urologist and nephrologist. This case lays emphasis on thoroughly investigating and managing a patient with bilateral emphysematous pyelonephritis and, in relation to its management, on the dilemma of whether the treatment of choice should be conservative or surgical.
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Competing interests None.
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