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Renal fungal ball
  1. M Wimalendra,
  2. A Reece,
  3. R M Nicholl
  1. Neonatal Unit, Northwick Park Hospital, North West London Hospitals NHS Trust, Harrow HA1 3UJ, UK; Richard.nichollnwlh.nhs.uk

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    Preterm infants are prone to fungal infections because of immaturity of their host defence systems (immunology and skin). Other risk factors include multiple antibiotic therapy, prolonged use of umbilical or percutaneous catheters, total parenteral nutrition, colonisation and/or past mucocutaneous candidiasis, low birth weight, endotracheal tube placement, and congenital malformation.

    Common sites for invasive candidiasis are the renal system, eyes, brain, and heart. Diagnostic tests should include blood and urine cultures, renal ultrasound, ophthalmological assessment, cardiac ultrasound, and examination of cerebrospinal fluid.

    Candiduria may indicate colonisation, but the presence of other clinical signs increases the risk of invasive candidiasis. Fungal ball is the commonest presentation of renal fungal disease.1 Clinical presentation may vary and can be obstructive, or non-obstructive, with renal failure.

    A baby born at 28 weeks gestation was known to be colonised with Candida spp in the first weeks of life. The mother had declined routine antenatal care. The baby was ventilator dependent, with umbilical lines and received multiple broad spectrum antibiotics for possible bacterial sepsis.

    After one month the baby developed thrombocytopenia and renal impairment. A renal ultrasound confirmed the presence of a solitary kidney with an echogenic mass.

    Limited postmortem examination revealed multiple abscesses in the renal parenchyma, which grew Candida albicans only.

    Invasive fungal infections in very low birthweight babies are currently the subject of a BPSU study (http://bpsu.inopsu.com/current.htm#Invasive).

    Figure 1

     Solitary kidney with echodensities.

    Figure 2

     Gross pathology, showing multiple fungal abscesses.

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