The authors report four cases of emphysematous pyelonephritis. All patients (3 females and 1 male) were diabetic. The clinical symptoms and signs were non-specific. The diagnosis was suggested in every case on conventional x-rays and was confirmed by computed tomography, which provides a detailed assessment of the lesions by demonstrating diffusion of gas in or beyond the renal compartment (2 cases). Urine cultures isolated an E. coli in one case and Klebsiella pneumoniae in 2 cases. In the fourth patient, Candida albicans was present in the urine at pathological levels, as confirmed by the presence of spores on histological examination of the nephrectomy specimen. The only effective treatment remains nephrectomy which was performed primarily in 2 cases or secondarily, after drainage, in the other 2 cases. The prognosis remains severe, with a high mortality; 2 of our patients died in a context of severe septic shock with end-stage renal failure.