Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
Department of Immunology and Inflammation, Imperial College London, London, UK.
BMJ Case Rep. 2023 Feb 10;16(2):e252313. doi: 10.1136/bcr-2022-252313.
Delayed graft function (DGF) is a common phenomenon following renal transplantation, which can be due to several factors. A rare cause includes invasive fungal infections, which can often be a challenge to diagnose. Nonetheless, prompt identification of such infections particularly within transplant patients is essential as they can lead to severe downstream sequelae, including graft loss and even death. We describe here a challenging case of fungal pyelonephritis complicating and potentially leading to DGF and further dialysis dependence within a renal transplant patient. Notably, we highlight the importance and clinical utility of biopsy to confirm the diagnosis, as investigations may be largely normal otherwise. Furthermore, we emphasise that with early identification of these infections, effective antifungal treatment can be commenced in a timely fashion leading to better patient outcomes and good graft function.
延迟移植物功能（DGF）是肾移植后常见的现象，其可能由多种因素引起。一个罕见的原因是侵袭性真菌感染，此类感染通常难以诊断。然而，对于此类感染，特别是对于移植患者，及时识别非常重要，因为它们可能导致严重的下游后果，包括移植物丢失甚至死亡。我们在此描述了一例棘手的真菌性肾盂肾炎病例，该病例并发并可能导致肾移植患者的 DGF 和进一步依赖透析。值得注意的是，我们强调了活检在确认诊断方面的重要性和临床实用性，因为否则检查结果可能基本正常。此外，我们强调，通过早期识别这些感染，可以及时开始有效的抗真菌治疗，从而改善患者的预后和保持移植物功能。
