How to cite this article: Pacheco-Mendoza B A, David M, Realpe. Gross Hematuria Post-Pieloplasty as Single Manifestation of Primary Renal Candidiasis.
Acad J Ped Neonatol. 2017; 4(4): 555685. DOI: 10.19080/AJPN.2017.04.555685
Primary Renal Candidiasis (PRC) has been described in pre-term and term newborn hospitalized in neonatal intensive care units (NICU). A risk factor for PRCis hydronephrosis. The aim of this paper is to present the case of a toddler suffering from PRC without hospitalization in intesive care units, and with gross hematuria pospieloplasty
A 3 year-old male was admitted in the hospital with fever and gastroalimentary vomiting. The diagnosis of hydronefrosis by ureteropelvic junction obstruction was established. Treatment with ceftriaxone and nephrostomy guided by ultrasonography (US) was applied. Three months later, pyeloplasty and pigtail placement were carried out. Two weeks after postpyeloplasty, the patient presented gross hematuria, with secondary anemia (Hb 6.5g/dl). Urine cultures positive for Candida albicans. US renal report fungoma of 7x5mm in left kidney. Management was done with fluconazole at 6 mg/kg/day by 6 weeks. Currently asymptomatic.
Primary renal candidiasis (PRC) has been described previously . Preterm newborn have risk factors for developing systemic or non-systemic candidiasis, because they are subject to intravenous broad spectrum antibiotics, parenteral nutrition, central venous catheters; among other factors. An important history in these patients is the presence of hydronephrosis .
The main clinical manifestation reported in the PRC has been anuria or oliguria secondary to mycetomas, fungomas obstructing the ureteropelvic junction, especially in pre-term patients [3,4].
The aim of this paper is to present the case of a toddler with PRC manifested by gross hematuria pospyeloplasty and being an outpatient.
After two weeks post-pyeloplasty, he presents gross hematuria
with clots, without abdominal pain. During physical examination
with heart rate (HR) of 125bpm, abdomen without bleeding in
surgical wound, no hematomas, no palpable mass.
PRC has been reported in term infants , preterm infants 
and, infants , commonly in intensives care units; but we do not
know of reports in a toddler as in the case that we are reporting.
Due to the use in the intensive care rooms, of broad spectrum
antibiotics, intravascular devices and parenteral nutrition, among
other factors, fungic systemic or localized infections have been
increasing [8,9]. But our patient does not belong to this group of
inpatients; he is a patient diagnosed from the outpatient clinic.
Most of the reported cases of PRC in children have as a common
denominator, the presence of ipsilateral hydronephrosis ,
similar to our patient; but also we added a risk factor that was the
use of nephrostomy for 3 months, which undoubtedly contributed
to the colonization of the kidney by candida.
PRC can manifest as pyelonephritis and/ or mycetomas .
In children we do not know of reports of pyelonephritis (PN) as
the only manifestation, but we do of PN plus mycetomas ,
or mycetomas at the ureteropelvic junction causing anuria or
oliguria [12,13]. The patient in the study, did not have obstruction
of the urinary tract, he had gross hematuria with acute anemia. We
found reports in adults of macroscopic hematuria in PRC , but
according to the review in the world literature this is the first case
reported with this clinical manifestation in toddler.
The diagnosis of PRC has been established by ultrasonography
(US), retrograde pyelography, excretory urography, anterograde
pyelography and tomography . The most used method is the
US. We established the diagnosis by US, and also followed up with
The treatment of primary renal candidiasis is based on
antifungal agents, the mostly used are fluconazole, amphotericin
and flucytosine [16,17]; we used fluconazole for 6 weeks with
complete resolution of symptom and mycetomas.
For the cases of obstructive uropathy secondary to mycetomas,
several treatments have been described, such as percutaneous
nephrostomy , percutaneous extraction of mycetomas with
thrombectomy devices ; none of these procedures was
necessary to use in our patient; gross hematuria finished with oral
This is the first report of a child with primary renal candidiasis,
manifested with anemising gross hematuria post-pyeloplasty.
We present this manifestation of primary renal candidiasis to be
considered in the differential diagnosis of a patient with hematuria
and history of pyeloplasty with chronic use of nephrostomy.