Department of Paediatric Nephrology, University Hospital of Wales, Cardiff CF14 4XW, UK.
Eur J Pediatr. 2011 Oct;170(10):1227-35. doi: 10.1007/s00431-011-1514-6. Epub 2011 Jun 22.
Renal candidiasis is an increasingly common condition affecting predominantly premature infants receiving neonatal intensive care or term infants with urogenital tract anomalies. Multiple risk factors are usually present. Although rare, some infants develop an obstructive uropathy due to fungal balls, and this requires prompt detection and intervention to preserve kidney function. The management of obstructive renal bezoars is challenging and not well summarised in the past. This is mainly due to scarce literature confined to case reports or case series only. This review clarifies various definitions used in relation to renal candidiasis and identifies infants particularly at risk of obstruction. Clinical presentation, diagnosis and the role of imaging are discussed. A summary of the recent literature is provided to outline the range of existing treatment options available with published drug dosages and mode of delivery used. No single approach is successful in all cases and clinicians need to be aware of the different options available: apart from adequate urinary drainage and use of systemic +/- local antifungal agents, additional treatment with fibrinolytic agents and/or endoscopic or open surgical removal may be required. A new simplified algorithm for use in management is proposed. We hope this review will help clinicians in their management of patients presenting with this complex and challenging diagnosis.
肾念珠菌病是一种日益常见的疾病，主要影响接受新生儿重症监护的早产儿或有泌尿生殖道异常的足月婴儿。通常存在多种危险因素。虽然罕见，但一些婴儿由于真菌球而发生梗阻性尿路病变，这需要及时发现和干预以保护肾功能。阻塞性肾贝佐尔斯的治疗具有挑战性，过去没有很好地总结。这主要是由于文献稀少，仅限于病例报告或病例系列。这篇综述澄清了与肾念珠菌病相关的各种定义，并确定了特别容易发生梗阻的婴儿。讨论了临床表现、诊断和影像学的作用。提供了近期文献综述，概述了现有的各种治疗选择，并列出了已发表的药物剂量和给药方式。没有单一的方法在所有情况下都有效，临床医生需要了解可用的不同选择：除了充分的尿路引流和使用全身性 +/- 局部抗真菌药物外，可能还需要使用纤维蛋白溶解剂和/或内镜或开放手术切除。提出了一种用于管理的简化新算法。我们希望本综述能帮助临床医生治疗这一复杂而具有挑战性的诊断。
