Fungal
bezoars may be a cause of urinary tract obstruction and
acute renal failure in neonates and young infants. We describe a female very low birth weight infant (25+3 weeks, 795 gram) who developed
renal insufficiency on the basis of systemic
fungal infection with fungal
bezoars in both kidneys. The girl was treated by local irrigation of the kidneys and bladder with
amphotericin B via percutaneously inserted bilateral
nephrostomy catheters, in combination with intravenous fluconazol. Renal function subsequently improved and after 11 weeks of treatment the
bezoars had disappeared sonographically. Follow-up of this child and the one we similarly treated for fungal
bezoars before, however, shows suboptimal renal function as assessed by the clearance of
creatinine and the mercapto acetyl
triglycine scan (MAG III). Until now, insufficient data are available yet to assess with certainly the long-term effects of fungal
bezoars on renal function. Based on our experience and a review of the recent literature (1980-1996) on systemic candidal
infections in premature infants, we recommend to perform regular renal ultrasound in any case of systemic candidal
infection in a prematurely born infant. If candidal
bezoars are found with pelvic obstruction, we suggest to start treatment by the insertion of bilateral
nephrostomy catheters and local irrigation with
amphotericin B in combination with systemic
antifungal agents, aiming at both the restoration of renal function and the eradication of the
fungal infection.