Transdermal nephrostomy as a therapeutical option for kid with fungous obstructive kidney disease

M. Xiromeritis

 Larissa, Greece

GENERAL:

Fungus balls rarely cause upper urinary tract obstruction, and they are most often found in patients with diabetes mellitus or impaired immunity. The computed tomography (CT) findings of fungal bezoars of the urinary tract are non-specific and have rarely been described, while in most cases, radiolucent filling defects are observed on excretory or retrograde urography. Only approximately 60 cases of fungal bezoars of the urinary tract have been reported [2,3]. The great majority have been associated with Candida species. There have been fewer than 20 cases of Aspergillus bezoars of the urinary tract [1,2]. Although almost all aspergillosis in the urinary tract has occurred in patients with predisposing conditions, such as diabetes mellitus, therapy with immunosuppressive agents or antibiotics, intravenous drug abuse, and malignancy .

Medical History: A fourteen years old boy with UPJ (ureter-pelvis junction stenosis). Without other diseases, infections or inherited diseases and with no medical treatment before. No constipation, urinary retention or other LUTS (low urinary tract syndrome) problems.

Treatment: His treatment was an open surgery plastic reconstruction of pelvis junction with placement of a ureter stent (pig tail). After three days had hydronephrosis.

Diagnosis: Three days after the operation the patient had lumbar pain and in the ultrasound appears hydronephrosis and fungal bezoars-balls. Blood examination demonstrated a peripheral white cell count of 14.3 × 109/l. His urea and creatinine levels were normal. Serum potassium concentration was 5.2 mmol/l, glucose concentration was  normall . HIV serology was negative and serum immunoglobulin levels were normal. Urinalysis demonstrated hematuria and pyuria.

Blood and urine cultures resulted positive for albicans candida. Renal tract ultrasound demonstrated unilateral hydronephrosis, and a diagnosis of unilateral fungal bezoar with obstructive nephropathy was made (Figure 1). Nephrostomy tube were inserted. Samples of the infiltrating mass were identified as Candida ALBICANS,sensitive to fluconazole (minimum inhibitory concentration (MIC)=2 μg/ml), amphotericin B (MIC=1 μg/ml), and caspofungin (MIC=0.25 μg/ml).

 General examination of urine and urine culture appears Candida Albicans.

New Treatment: The placement of a transdermal nephrostomy was judged necessary and kept it for fifteen (15) days. Through the nephrostomy we deliver to the pelvis Fungizone 50 mg (amfoterikin B),and per os gave Fungostatin 150 mg .

Results: After 15 days all the examinations were normal.

  • Ultrasound
  • Urine examination
  • biochemical profile
  • pelvis-uretero graphy

Conclusion: Transdermal nephrostomy offers a good, satisfied and effect alternating therapy for fungal obstructive inflammations of the kidney in kids and new born baby.

It’s the most minimal invasive procedure and has effect either wise the inflammation-disease is topical or systemic.

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Figure 3.

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š1. Irby PB, Stoller ML, McAninch JW. Fungal bezoars of the upper urinary tract. J Urol. 1990;143:447–451. [PubMed]

 

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5. Bhayani SB, Siegel CL. Urinary tract imaging: basic principles. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Campbell-Walsh urology. 9th ed. Philadelphia: Saunders; 2007. pp. 127–135.

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