Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 1 4 2017 06 24 110 114 EN Shahram Gooran Urologic Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Reza Dehghaniathar Urologic Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Gholamreza Pourmand Urologic Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran 2015 11 29 2016 09 24 Emphysematous  pyelonephritis is a urologic emergency condition characterized by an acute  and severe necrotizing parenchymal and perirenal infection caused by Gas-forming uropathogens. predisposing  factors include diabetes,immunosuppression conditions, urinary tract obstruction associated with urinary calculi or papillary necrosis and significant renal functional impairment. The overall mortality rate has been reported to be between19%to 43% and few cases in kidney allograft have been reported. All of the documented cases of emphysematous pyelonephritis have occurred in adults Juvenile diabetic patients do not appear to be at risk. Female are affected more often than male.we report A 66-year-old  diabetic man with ESRD (end stage renal disease) received deceased renal transplant two mounts after transplantation admitted in hospital , with complain of reduced urine out-put an increase in serum creatinine (Cr) level,fever and abdominal pain.. The patient was treated with 250 mg intravenous imipenem q12h and 1 g intravenous vancomycin  and patient take under hemodialysis  every other day for one week, An ultrasound guided percutaneous  nephrostomy accomplished  and  fortunately he did  considerably respond clinically and radiologically the transplanted kidney  was saved. https://crcp.tums.ac.ir/index.php/crcp/article/view/16 https://crcp.tums.ac.ir/index.php/crcp/article/download/16/58