Clark M A, Gaunt T, Czachor J S
Wright State University School of Medicine, Department of Obstetrics and Gynecology, Dayton, OH 45409, USA.
Mil Med. 1999 Mar;164(3):239-41.
Few data exist concerning the combined use of fluconazole systemically and as an irrigant for nephrostomy tubes in a patient with renal candidiasis. The patient described here presented with renal fungal balls obstructing the drainage of urine from her nephrostomy tubes.
Twelve months after chemoradiation for a stage IIB squamous cell carcinoma of the uterine cervix, a 35-year-old woman presented with renal obstruction necessitating insertion of ureteral stents. After 6 months of chemotherapy, the patient developed uremia. After nephrostomy tubes were placed, renal candidiasis was noted, and fluconazole was begun systemically. When the renal candidiasis failed to clear, nephrostomy tube irrigations were begun.
Fourteen days of therapy with fluconazole resulted in the resolution of the uremia. The patient died 6 months later with her nephrostomy tubes in situ and without evidence of candidiasis in her urinary tract.
The patient described was successfully treated without having to remove her nephrostomy tubes. Two other authors have reported the successful use of fluconazole irrigation to treat candidiasis in nephrostomy tubes that was unresponsive to systemic fluconazole. Before the appearance of these reports, the best results were obtained with removal of the catheter in renal candidiasis.
关于氟康唑在肾念珠菌病患者中全身使用并作为肾造瘘管冲洗液联合应用的数据很少。本文所述患者出现肾真菌球阻塞其肾造瘘管尿液引流。
一名35岁女性在接受子宫颈IIB期鳞状细胞癌放化疗12个月后，出现肾梗阻，需要插入输尿管支架。化疗6个月后，患者发展为尿毒症。放置肾造瘘管后，发现肾念珠菌病，并开始全身使用氟康唑。当肾念珠菌病未能清除时，开始进行肾造瘘管冲洗。
氟康唑治疗14天导致尿毒症消退。患者6个月后死亡，肾造瘘管仍在位，尿路无念珠菌病证据。
所述患者成功接受治疗，无需拔除肾造瘘管。另外两名作者报告成功使用氟康唑冲洗治疗对全身氟康唑无反应的肾造瘘管念珠菌病。在这些报告出现之前，肾念珠菌病的最佳治疗结果是拔除导管。
