Renal candidiasis most often occurs as the result of a patient having candidemia, disseminated or systemic candidiasis. This is where the patient has a candida throughout the body, being spread around various organs in the blood stream, including the kidneys.
Predisposing factors for renal candidiasis
- constriction of the urinary tract
- urethral or bladder catheters
- localized papillary necrosis
- nephrostomy tubes
- permanent indwelling devices
- patients who are immunocompromised because of tumor, AIDS, chemotherapy, or immunosuppressants
- Renal transplantation
Symptoms and complications of renal candidiasis
- fever that is resistant to antibiotic treatment
- lumbar pain
- abdominal pain
- a fungal ball in the renal pelvis
- emphysematous cystitis
- Lower or upper tract obstruction
- Papillary necrosis
- intrarenal and perinephric abscesses
- deteriorating renal function
- possible candidiasis in other sites
Sometimes a physical examination will not reveal any specific problem relating to the kidney and diagnosis is made with a urinalysis and renal biopsy, or found during an autopsy. However even though 80% of patients with disseminated candidiasis have renal candidiasis, urine cultures on their own are not 100% reliable as a diagnosis. For a confirmed renal candidiasis infection there should be positive blood cultures, the isolation of yeasts in urine specimens obtained by suprapubic aspiration and a positive immunodiffusion precipitin test result. However a lot of doctors do not recommend suprapubic aspirates because they are invasive and need expertise to perform, particularly if the patient is immunocompromised.
Treatment of renal candidiasis
Catheters should be removed where possible. IV amphotericin B can be administered as well as high-dose oral fluconazole. Both are systemic anti-fungal drug treatments.
Infants with renal candidiasis
Infants in neonatal care units are also susceptible to renal candidiasis. In a study done that examined medical records over a 11 year period, 41 infants with candiduria were identified. 36 infants had further renal imaging studies performed, 42% had renal candidiasis. The study concluded that serial renal ultrasounds are needed to reliably detect late appearing renal fungal balls, a symptom of renal candidiasis.