Emphysematous pyelonephritis is an uncommon, but life-threatening necrotizing inflammation of renal parenchyme and perinephric tissue by gas-forming organisms. This disease is encountered mainly in patients with uncontrolled diabetes mellitus and/or urinary tract obstruction etc. Though the pathogenesis of this diseases is still poorly understood, radiographic demonstration of gas shadow in renal parenchyme and peri-nephric tissue establishes the diagnosis of emphysematous pyelonephritis. The identification of this finding has been believed to consider incision and drainage or nephrectomy in addition to medical treatment, because of high mortality rate of this disease in spite of vigorous medical management. We report two cases of emphysematous pyelonephritis complicated in 62-year-old female and 48- year-old male patients with diabetes mellitus. Nephrectomies were not performed because of bilateral emphysematous pyelonephritis in one patient and of refusal of nephrectomy by the other patient. But patients were recovered completely on medical management.