From the Guidelines
Candidal pyelonephritis is a serious fungal infection of the kidneys that requires prompt treatment with antifungal medications, such as fluconazole or amphotericin B, to prevent morbidity and mortality.
Definition and Causes
Candidal pyelonephritis is a fungal infection of the kidneys caused by Candida species, most commonly Candida albicans. This condition typically occurs in immunocompromised patients, those with diabetes, individuals with urinary tract abnormalities, or patients who have received prolonged antibiotic therapy 1.
Treatment
Treatment usually involves antifungal medications such as fluconazole (starting at 400 mg on day 1, followed by 200-400 mg daily for 2-4 weeks) or amphotericin B (0.5-0.7 mg/kg/day IV) for more severe cases, as recommended by the Infectious Diseases Society of America 1.
Complicated Infections
For complicated infections or those caused by resistant Candida species, echinocandins like caspofungin (70 mg loading dose, then 50 mg daily) may be necessary, although their use is not well established for urinary tract infections 1.
Underlying Factors
Any underlying predisposing factors should be addressed, including removal of urinary catheters if present and control of diabetes.
Surgical Intervention
Surgical intervention may be required if there are obstructions or abscesses.
Diagnosis
Candidal pyelonephritis occurs when Candida organisms ascend from the lower urinary tract or spread hematogenously to the kidneys, where they cause inflammation and tissue damage. The diagnosis is confirmed by finding Candida in urine cultures with clinical signs of kidney infection, often requiring imaging studies like CT scans to assess the extent of infection 1. Some key points to consider in the treatment of candidal pyelonephritis include:
- The ability of the antifungal agent to achieve adequate concentrations in the urine is crucial for effective treatment 1.
- Fluconazole is the drug of choice for treating Candida UTI, due to its high concentrations in the urine and efficacy against most Candida species 1.
- AmB deoxycholate is active against most Candida species, but its use is limited by the need for intravenous administration and toxicity 1.
From the Research
Definition and Causes of Candidal Pyelonephritis
- Candidal pyelonephritis is a type of urinary tract infection caused by Candida species, which can infect the kidneys and cause inflammation [(2,3)].
- The infection can occur through hematogenous spread following candidemia or through the retrograde route via the urethra [(2,3)].
- Risk factors for Candida urinary tract infections include diabetes mellitus, indwelling urinary catheters, use of broad-spectrum antibiotics, urinary obstruction, and admission to intensive care units 2.
Symptoms and Diagnosis
- Symptoms of Candida pyelonephritis are similar to those of other urinary tract infections and can include pyuria, which is a nonspecific finding 4.
- The diagnosis of Candida pyelonephritis requires a careful evaluation, including verification of funguria by repeating urinalysis and urine culture 4.
- Imaging studies such as ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) may be used to diagnose pyelonephritis or perinephric abscess 4.
Treatment
- Fluconazole is the treatment of choice for symptomatic Candida urinary tract infections, including pyelonephritis, as it achieves high urinary levels 2.
- Amphotericin B deoxycholate is an alternative antifungal agent that can be used if fluconazole cannot be used due to resistance, allergy, or failure [(2,5)].