Emphysematous pyelonephritis is a rare necrotizing parenchymal infection of the kidney. It is associated with the production of gas from fermentation of glucose and usually found in diabetic patients. This report coucerus two elderly female diabetic patients. In emergency room, plain abdominal radiography and corn puted tomography showed gas within the renal pelvic and upper ureters. After surgical treatment (percutaneous nephrostomy or nephrectomy) and aggressive medical therapy. The patient conditions were much improved and discharge followed. Because of the specific radiography findings and high motality rate of emphysematous pyelonephritis, these two cases are reported.