Primary Renal Candidiasis

Candida organisms are common fungal saprophytes of the gastrointestinal tract, oral cavity, and vagina.¹ However, if host resistance is altered by chronic disease, malignancy, diabetes mellitus, adrenocorticosteroids, or antibiotics, Candida species may be found in sites normally free of saprophytic infection. When these organisms become systemic invaders of man, they usually produce a fatal, fulminant clinical course with candidemia, fever, hypotension, tachycardia, and invasion of the lungs, heart, and kidney.^2-5 On rare occasion, they may become a primary, pathogenic invader of the kidneys without the presence of candidemia or other systemic organ involvement.⁶ A total of nine well-documented cases of primary renal candidiasis in adults have been reported since Albers⁷ described the first two patients in 1953.^7-13 The purpose of this communication is to review the nine previous patients with adult primary renal candidiasis and report two additional patients with very unusual features. Both of our patients had juvenile diabetes, and neither demonstrated generalized systemic candidiasis or candidemia. One patient presented to the hospital after he passed on urination several large fungus balls which consisted of C albicans pseudomycelial elements (Fig 1 and 2). The second patient developed a C albicans perinephric abscess which is believed to be the result of metastatic seeding from a previous C albicans skin abscess. The passage of fungus balls or the occurrence of a perinephric abscess has not been previously observed in primary renal candidiasis. Both patients were treated with intravenous doses of amphotericin B, and both have survived for a long interval with no evidence of recurrent C albicans infection.