Successful management of a renal fungal ball in a pretermature neonate: A case report and review of literature

Abstract

Invasive fungal infection is common in the present day NICUs - generally manifesting as candiduria or candida sepsis. Fungal balls in the kidneys are very uncommon and most are amenable to higher antifungal agents. However, we had a child who did not respond to such measures and ultimately needed a surgical removal of the fungal ball in his kidney.We report this case along with a review of literature to highlight about this uncommon, but an important cause of persistent sepsis in pre-term infants and to review the treatment options including a surgical removal.

Successful Endoscopic Management of a Renal Fungal Ball using Flexible Ureterorenoscopy

“…Most of the reported cases of fungal ball in literature were managed by either long term antifungal therapy or local antifungal instillation through a nephrostomy tube [1,12,13,15,16]. Current management options for renal fungal ball include intravenous antifungal agents, percutaneous nephrostomy with instillation of antifungal agents with no consensus over the duration of instillation required.…”

Obstructive Renal Failure Caused by Bilateral Renal Candidiasis and Hypoplastic Renal Pelvises in a Preterm Infant: Case Presentation and Review of the Literature

“…In the presence of positive urine culture for Candida and in the absence of hematuria or pyuria, the nonshadowing echogenic material in pyelocalyceal system may be in favor of renal candidiasis (40,41).…”

“…Although invasive candidiasis is uncommon in term infants, yet is more frequent in premature cases, and the presence of positive urine culture in this high-risk group should be considered significant (16,(40)(41)(42).…”

“…Invasive renal candidiasis and fungal balls are uncommon and the most important predisposing factors include low urinary pH, urinary stasis due to poor urine output, congenital renal anomalies and administration of frequent courses of broad-spectrum antibiotics (40,41).…”

Brief report: Fungal balls in the urinary tract of an infant

“…[4] Neonatal mortality with invasive candidiasis is 10–15%. [3] LBW babies may be endowed with lower nephron dosing; further damage leads to chronic kidney disease.…”