本文报告急性肾盂肾炎首次发作后出现肾病综合征和肾乳头坏死一例。患者男,42岁。因发热、寒战、胁腹部痛住院。入院时体温38.3℃,两肋脊角触痛,脓尿,尿培有养大肠杆菌,每立方毫米菌落超过10万个。用强力霉素2天,热退。住院第3～40天,患者血浆蛋白从2.5克％下降到1.8克％,双下肢浮肿2+,尿蛋白增高到7.7克/24小时。 This article reports a case of nephrotic syndrome and renal papillary necrosis after the first episode of acute pyelonephritis. Male patient, 42 years old. Due to fever, chills, belly pain in hospital. Body temperature at admission 38.3 ℃, Liang rib angle tenderness, pyuria, urinary culture Escherichia coli, per cubic millimeter more than 100,000. With doxycycline 2 days, hot retreat. On days 3 to 40, the patient’s plasma protein decreased from 2.5 to 1.8 grams, his lower extremity edema was 2+, and his urinary protein increased to 7.7 grams / 24 hours.