DOI: https://doi.org/10.36347/sjmcr.2026.v14i04.031

Pages: 716-719

Pyonephrosis is a severe suppurative infection of an obstructed collecting system and represents an advanced form of infected upper urinary tract obstruction. In the setting of chronic stone disease, persistent obstruction, urinary stasis, recurrent infection, and progressive elevation of intrapelvic pressure may lead to irreversible destruction of the renal parenchyma and functional exclusion of the affected kidney. In symptomatic patients with negligible residual renal function, nephrectomy may therefore represent the most relevant definitive treatment. We report the case of a 58-year-old woman with diabetes mellitus and a history of left renal lithiasis who presented with a symptomatic pyonephrotic left kidney. Renal scintigraphy showed a split renal function of 5% on the affected side. Given the persistence of symptoms, the chronic infectious process, and the nearly absent functional value of the kidney, total nephrectomy was performed. The postoperative course was uneventful, with drain removal on postoperative day 1 and discharge on day 2. At 3-month follow-up, the patient remained asymptomatic and overall renal function was preserved. This case illustrates the pathophysiological progression from chronic lithiasic obstruction to pyonephrosis and renal parenchymal destruction, and emphasizes the clinical relevance of nephrectomy when the diseased kidney has become both symptomatic and functionally insignificant.