Candidal mycetoma in the neonatal kidney

Objective. To determine the natural history of renal mycetoma (fungal balls) in the neonate. Design. Retrospective chart review of all neonatal intensive care unit patients with systemic candidiasis and sonographic evidence of renal mycetoma admitted to the Duke University Medical Center between January 1, 1993, and July 1, 1998. Results. Fourteen patients were reviewed. Three died from fungemia, and 3 died from other causes months after completing treatment. Ten patients had urine cultures obtained within 1 week of diagnosis; each had a positive routine or fungal urine culture for candida. The rate of improvement of renal mycetoma by ultrasound was variable, ranging from 10 days to 4 months and was not predictive of survival or long-term renal function. All patients who were discharged from the hospital had creatinine less than or equal to 0.5 mg/dL on discharge. Only 1 patient had surgical intervention (nephrostomy tube placement). Of the 11 patients who survived fungemia, 7 were treated for 3 weeks from the time negative cultures were obtained, while 4 were treated for 5 weeks or more after negative cultures. A declining platelet count was suggestive of fungemia in the patients we reviewed. Conclusions. For our patients with renal mycetoma without complete obstruction (patients continued to have urine output) surgical intervention was rarely necessary, the rate of sonographic improvement neither correlated with clinical course nor necessitated longer therapy, and long-term creatinine levels were normal. Sustained declines in platelet count of 10% per day or more in a neonate on broad-spectrum antibiotics for suspected sepsis may be indicative of fungemia.