Candida infections of the bladder and kidneys
- Gary M Cox, MD
Gary M Cox, MD
- Professor of Medicine
- Duke University Medical Center
- Carol A Kauffman, MD
Carol A Kauffman, MD
- Section Editor — Fungal Infections
- Professor of Internal Medicine
- University of Michigan Medical School
- Veterans Affairs Ann Arbor Healthcare System
Funguria is common in hospitalized patients and is generally benign. Invasive infection of the kidney is unusual and is difficult to treat. The vast majority of fungal infections of the kidney and bladder result from Candida albicans and other Candida species. A variety of other fungi can rarely involve the kidney as a result of disseminated infection. These include:
●Mucorales (eg, Rhizopus, Mucor species)
- Fisher JF, Kavanagh K, Sobel JD, et al. Candida urinary tract infection: pathogenesis. Clin Infect Dis 2011; 52 Suppl 6:S437.
- Ryley JF, Ryley NG. Candida albicans--do mycelia matter? J Med Vet Mycol 1990; 28:225.
- Achkar JM, Fries BC. Candida infections of the genitourinary tract. Clin Microbiol Rev 2010; 23:253.
- Negri M, Silva S, Henriques M, et al. Candida tropicalis biofilms: artificial urine, urinary catheters and flow model. Med Mycol 2011; 49:739.
- Sobel JD, Fisher JF, Kauffman CA, Newman CA. Candida urinary tract infections--epidemiology. Clin Infect Dis 2011; 52 Suppl 6:S433.
- Kauffman CA. Diagnosis and management of fungal urinary tract infection. Infect Dis Clin North Am 2014; 28:61.
- Bouza E, San Juan R, Muñoz P, et al. A European perspective on nosocomial urinary tract infections I. Report on the microbiology workload, etiology and antimicrobial susceptibility (ESGNI-003 study). European Study Group on Nosocomial Infections. Clin Microbiol Infect 2001; 7:523.
- Kauffman CA, Vazquez JA, Sobel JD, et al. Prospective multicenter surveillance study of funguria in hospitalized patients. The National Institute for Allergy and Infectious Diseases (NIAID) Mycoses Study Group. Clin Infect Dis 2000; 30:14.
- Alvarez-Lerma F, Nolla-Salas J, León C, et al. Candiduria in critically ill patients admitted to intensive care medical units. Intensive Care Med 2003; 29:1069.
- Bougnoux ME, Kac G, Aegerter P, et al. Candidemia and candiduria in critically ill patients admitted to intensive care units in France: incidence, molecular diversity, management and outcome. Intensive Care Med 2008; 34:292.
- Colodner R, Nuri Y, Chazan B, Raz R. Community-acquired and hospital-acquired candiduria: comparison of prevalence and clinical characteristics. Eur J Clin Microbiol Infect Dis 2008; 27:301.
- Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in medical intensive care units in the United States. National Nosocomial Infections Surveillance System. Crit Care Med 1999; 27:887.
- Irby PB, Stoller ML, McAninch JW. Fungal bezoars of the upper urinary tract. J Urol 1990; 143:447.
- Johnson JR, Ireton RC, Lipsky BA. Emphysematous pyelonephritis caused by Candida albicans. J Urol 1986; 136:80.
- Hildebrand TS, Nibbe L, Frei U, Schindler R. Bilateral emphysematous pyelonephritis caused by Candida infection. Am J Kidney Dis 1999; 33:E10.
- High KP, Quagliarello VJ. Yeast perinephric abscess: report of a case and review. Clin Infect Dis 1992; 15:128.
- Ang BS, Telenti A, King B, et al. Candidemia from a urinary tract source: microbiological aspects and clinical significance. Clin Infect Dis 1993; 17:662.
- Gross M, Winkler H, Pitlik S, Weinberger M. Unexpected candidemia complicating ureteroscopy and urinary stenting. Eur J Clin Microbiol Infect Dis 1998; 17:583.
- LEHNER T. SYSTEMIC CANDIDIASIS AND RENAL INVOLVEMENT. Lancet 1964; 1:1414.
- Safdar N, Slattery WR, Knasinski V, et al. Predictors and outcomes of candiduria in renal transplant recipients. Clin Infect Dis 2005; 40:1413.
- Hitchcock RJ, Pallett A, Hall MA, Malone PS. Urinary tract candidiasis in neonates and infants. Br J Urol 1995; 76:252.
- Phillips JR, Karlowicz MG. Prevalence of Candida species in hospital-acquired urinary tract infections in a neonatal intensive care unit. Pediatr Infect Dis J 1997; 16:190.
- Vázquez-Tsuji O, Campos-Rivera T, Ahumada-Mendoza H, et al. Renal ultrasonography and detection of pseudomycelium in urine as means of diagnosis of renal fungus balls in neonates. Mycopathologia 2005; 159:331.
- Kauffman CA, Fisher JF, Sobel JD, Newman CA. Candida urinary tract infections--diagnosis. Clin Infect Dis 2011; 52 Suppl 6:S452.
- Argyle C, Schumann GB, Genack L, Gregory M. Identification of fungal casts in a patient with renal candidiasis. Hum Pathol 1984; 15:480.
- Sadegi BJ, Patel BK, Wilbur AC, et al. Primary renal candidiasis: importance of imaging and clinical history in diagnosis and management. J Ultrasound Med 2009; 28:507.
- Erden A, Fitoz S, Karagülle T, et al. Radiological findings in the diagnosis of genitourinary candidiasis. Pediatr Radiol 2000; 30:875.
- Pappas PG, Kauffman CA, Andes D, et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 2009; 48:503.
- Fisher JF, Sobel JD, Kauffman CA, Newman CA. Candida urinary tract infections--treatment. Clin Infect Dis 2011; 52 Suppl 6:S457.
- Sobel JD, Kauffman CA, McKinsey D, et al. Candiduria: a randomized, double-blind study of treatment with fluconazole and placebo. The National Institute of Allergy and Infectious Diseases (NIAID) Mycoses Study Group. Clin Infect Dis 2000; 30:19.
- Jacobs LG, Skidmore EA, Freeman K, et al. Oral fluconazole compared with bladder irrigation with amphotericin B for treatment of fungal urinary tract infections in elderly patients. Clin Infect Dis 1996; 22:30.
- Simpson C, Blitz S, Shafran SD. The effect of current management on morbidity and mortality in hospitalised adults with funguria. J Infect 2004; 49:248.
- Drew RH, Arthur RR, Perfect JR. Is it time to abandon the use of amphotericin B bladder irrigation? Clin Infect Dis 2005; 40:1465.
- Sobel JD, Bradshaw SK, Lipka CJ, Kartsonis NA. Caspofungin in the treatment of symptomatic candiduria. Clin Infect Dis 2007; 44:e46.
- Malani, AN. Failure of caspofungin for treatment of Candida glabrata candiduria: Case report and review of the literature. Infect Dis Clin Pract 2010; 18:271.
- Albano L, Bretagne S, Mamzer-Bruneel MF, et al. Evidence that graft-site candidiasis after kidney transplantation is acquired during organ recovery: a multicenter study in France. Clin Infect Dis 2009; 48:194.
- Osmán I, Barrero R, León E, et al. Mycotic pseudoaneurysm following a kidney transplant: a case report and review of the literature. Pediatr Transplant 2009; 13:615.
- EPIDEMIOLOGY AND RISK FACTORS
- INFECTION VERSUS COLONIZATION
- NATURAL HISTORY
- CLINICAL CHARACTERISTICS
- Candidemia-associated infection
- Ascending infection
- Asymptomatic candiduria
- Symptomatic candiduria
- - Fluconazole
- - Amphotericin B
- - Flucytosine
- - Other agents
- Perinephric abscess
- Fungus balls
- In renal transplantation
- SUMMARY AND RECOMMENDATIONS
- Risk factors and clinical presentation