J Korean Pediatr Soc.  2000 Nov;43(11):1495-1500.

A Case of Obstructive Renal Cndidiasis Treated with Percutaneous Nephrostomy in Prematurity

• Lim SM
• Kim ER
• Woo JJ
• Kwak BK

Abstract

The improved survival rate of premature infants requiring intensive care, shows an increased risk for nosocomial infections such as disseminated fungal infection. Renal candidasis usually occurs secondary to systemic disease, and can Iead to obstructive uropathy by fungus ball. A male neonate was born in week 28 of the gestational period. His birth weight was 1200gm. He required mechanical ventilation and surfactant for respiratory distress syndrome, umbilical artery and vein catheterization, percutaneous central veneous catheterization(PCVC) for parenteral nutrition, steroid, aminophylline and broad spectrum anibiotics. Hypertension developed on the 29th hospital day, but was not controlled by diuretics and antihypertensive drugs. on the 40th hospital day, he had abdominal distension, anuria, and azotemia. A Renal ultrasonogram showed that the ureteropelvic junction of the left kidney was completely obstructed with fungus balls. A percutaneous nephrostorny tube, made in a pigtail shape by hand, was inserted under fluoroscopy guidance, and the obstruction of the pelvis was resolved by wire manipulation. Parenteral amphotericin B and oral flucytocine were started, and the left renal pelvis was directly drained and irrigated by percutaneous nephrostomy tube. Candida albicans(C. albicuns) was cultured from urine and a percutaneous central venous catheter tip. His general condition improved, and follow up urine culture revealed no fungus. On follow-up renal ultrasonogram, renal cortex echogenicity and fungus ball had disappeared except for mild left renal calyectasis and pelvic thickening. This report describes a case of obstructive uropathy by fungus ball in systemic candidiasis of prematurity, and reviews the related literature.

Keyword

Renal candidiasis; Fungus ball; Percutaneous nephrostomy; Prematurity

MeSH Terms

Aminophylline
Amphotericin B
Antihypertensive Agents
Anuria
Azotemia
Birth Weight
Candida
Candidiasis
Catheterization
Catheters
Central Venous Catheters
Cross Infection
Diuretics
Fluoroscopy
Follow-Up Studies
Fungi
Hand
Humans
Hypertension
Infant, Newborn
Infant, Premature
Critical Care
Kidney
Kidney Pelvis
Male
Nephrostomy, Percutaneous*
Parenteral Nutrition
Pelvis
Respiration, Artificial
Survival Rate
Ultrasonography
Umbilical Arteries
Veins
Aminophylline
Amphotericin B
Antihypertensive Agents
Diuretics