Acute extrarenal kidney damage in the course of infection with fungal strain of Candida glabrata in a patient with type 2 diabetes

Background: Acute renal injury is becoming a significant epidemiological problem among patients requiring hospital treatment. Extrarenal aetiology of the kidney injury is recognized in 5 % to 10 % of hospitalized patients; however, the identification of the mycelium of the Candida glabrata as the direct factor causing the acute urinary obstruction is extremely rare. Case Report: A 64-year-old woman was admitted to the clinic because of progressing weakness, nausea and vomiting, poor appetite and reduced urination. On admission, laboratory findings revealed pyuria, inflammatory changes, acute renal failure (eGFR-MDRD 6 ml/min), and hyperglycemia. The patient underwent USG of the abdominal cavity, which showed bilateral hydronephrosis, with lithiasis on the right site. Cystoscopy done the next day revealed that the mucous membrane of the bladder was reddened and had a white coating. During the next several days, a renal fistula was created on the left and right sides. Candida glabrata was isolated from urine, and was sensitive only to voriconazole. V-fend (voriconazole) treatment resulted in increase of diuresis and decrease in creatinine and urea levels. Conclusions: Urinary tract infection caused by Candida glabrata causes significant therapeutic problems. In most cases, these yeasts are resistant to triazole anti-fungal drugs such as fluconazole, which translates into significantly increased mortality of patients. To date, a similar case was described only by one group of doctors, however, due to the intensity of the currently used immunosuppression and multiantibiotic therapy, increased incidence of diabetes and the aging of the population, it is expected that the prevalence of this clinical problem will increase. (authors)