Renal candidiasis complicating nephrolithiasis experience and management

ABSTRACT

Urinary candidiasis may present as asymptomatic candiduria or as a life threatening candidal pyelonephritis, anuria and fungemia. Overlooked candidal infection in the surgical patients leads to increased morbidity and hospital stay. Eighteen patients with stag horn renal calculi complicated with renal candidiasis were studied. All patients had diabetes for at least two years prior to presentation with a history of antibiotic therapy for a variable duration. Pyuria was constant and E. coli infection was present in 77.8%. Candida albicans was diagnosed by microscopic examination of Gram stained smears of urine and grew in urine cultures in counts from 16000 to 37000/ml. Surgical removal of the stones was done in all cases. Postoperative nephrostomy tube irrigation with Amphotericin B was done for an average of 8 days and oral flucytosine was added in 5 resistant cases. Antifungal treatment was well tolerated by all patients. In the absence of obstruction or residual calculus eradication of candiduria within few days with no postoperative complications is expected with local and /or systemic antifungal treatment