Papillary necrosis with invasive fungal infections: a case series of 29 patients.
BACKGROUND
Renal papillary necrosis (RPN) is associated with a number of comorbid conditions. However, it has been rarely reported in patients with fungal infections of the kidney.


METHODS
We analyzed medical records of our hospital for the last two decades and identified 29 patients with fungal infections and RPN.


RESULTS
Among the 29 patients, there were 24 men and 5 women. The median (range) age at presentation was 31.2 years (2 days-73 years). Three patients (10%) were kidney transplant recipients. The remaining had varied co-existing medical conditions that included diabetes mellitus in 16 (55%) and septicemia in 4 (14%). Clinical features at presentation were fever and oliguric kidney failure in 17 patients and loin pain accompanied by passage of fleshy material per urethra in 11 (38%). Diagnosis was made ante-mortem in 17 (59%) patients. Twenty patients (69%) had infection limited to the kidneys, while in the rest, it was disseminated. Kidney involvement was bilateral in 17 patients (59%). Urinalysis showed pyuria in 23 (79%) and microhematuria in 8 (28%) patients. Fungal infections included candidiasis (69%), aspergillosis (21%) and zygomycosis (10%). Of the 17 patients in whom the diagnoses was made ante-mortem, 12 survived and 5 died. Overall mortality was observed in 48% of cases.


CONCLUSIONS
We herein report a series of patients with RPN associated with fungal infections of the kidney. Presentation varies from asymptomatic urinary tract infection to severe kidney failure with poor outcome. High index of suspicion is necessary to reduce the associated high mortality in these patients.
Department of Nephrology , Postgraduate Institute of Medical Education and Research , Chandigarh , India.
Krishan L
KL
Gupta
Department of Nephrology , Postgraduate Institute of Medical Education and Research , Chandigarh , India.
Thangamani
T
Muthukumar
Department of Pathology , Postgraduate Institute of Medical Education and Research , Chandigarh , India.
Kusum
K
Joshi
Department of Medical Microbiology , Postgraduate Institute of Medical Education and Research , Chandigarh , India.
Arunaloke
A
Chakrbarti
Department of Nephrology , Postgraduate Institute of Medical Education and Research , Chandigarh , India.
Harbir S
HS
Kohli
Department of Nephrology , Postgraduate Institute of Medical Education and Research , Chandigarh , India.
Vivekanand
V
Jha
Department of Nephrology , Postgraduate Institute of Medical Education and Research , Chandigarh , India.
Vinay
V
Sakhuja
candidiasis; diabetes mellitus; fungal infections; renal papillary necrosis