Emphysematous Pyelonephritis with IgA-Dominant Infection-Related Glomerulonephritis: An Unusual Picture

OBJECTIVE. The aim of this case report is to illustrate a very rare case of emphysematous pyelonephritis complicated by IgA-dominant postinfectious glomerulonephritis. CASE REPORT. We report the case of a 53-year-old woman with emphysematous pyelonephritis who initially presented with unintentional weight loss for 3 months and subnephrotic range proteinuria without fever. Urinalysis revealed proteinuria, microscopic hematuria, and pyuria. A kidney biopsy was performed for suspected glomerulonephritis. The patient’s right kidney biopsy was consistent with immunoglobulin A (IgA)-dominant infection-related glomerulonephritis. Abdominal computed tomography to seek the possible source of infection revealed staghorn stones obstructing dilated calyces and gas collection within the collecting system. The final diagnosis was emphysematous pyelonephritis of the left kidney complicated by IgA-dominant infection-related glomerulonephritis of the right kidney. CONCLUSION. We present an atypical presentation of emphysematous pyelonephritis in terms of clinical presentation (prolonged course of illness without fever) and its complications (IgA-dominant infection-related glomerulonephritis). This case study highlights the critical role of kidney biopsy in the diagnosis and the diverse clinical manifestations in clinical medicine.