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Pyonephrosis is a rare pathology causing destruction of the renal parenchyma.The diagnosis of pyonephrosis was made on the basis of radiological images and cytobacteriological examination of the urine.A patient of 49 years old, followed for 10 years under insulintherapy was admitted for a massive pyonephrosis of the left kidney.The clinical examination found a conscious patient, febrile at 38 °C,an abdominal distension with a tenderness at the level left hypochondrium. the pus was drained by percutaneous nephrostomy that has brought up 5L pus.A left nephrectomy was performed in front of a non-functioning kidney.