Fungal infections and the kidney
Author:
Gupta KL
Date: 4 April 2004
Abstract:
Invasive fungal infections have gained importance recently. The opportunistic pathogens such as Candida, Aspergillus, Mucor, Cryptococcus, and Histoplasma are particularly known to infant the kidneys in predisposed individuals with serious complications. At the same time there is a high incidence of invasive fungal infections in patients with renal disease and kidney transplant recipients under effects of immunosuppression and environmental exposure. The clinicopathological features and outcome were analysed in 90 patients of systemic mycoses with renal involvements, seen at PGIMER, Chandigarh, during the period Jan 1981-Aug 2001. The fungal infections comprised of candidiasis (30), mucormycosis (28), aspergillosis (27), cryptococcosis (4) and histoplasmosis (1). Mucormycosis had most severe presentation. Acute renal failure was the main clinical feature in all except one of the 23 cases with bilateral renal involvement (95.6 percent). In aspergillosis renal failure occurred in 55 percent of patients. Renal candidiasis presented with renal papillary necrosis in half of the patients and renal failure occurred in 40 percent in association with other comorbid conditions. There was no clinical evidence of involvement in those with disseminated cryptococcosis of histoplasmosis in which renal lesions were only found at autopsy. Outcome was very poor with 82 percent overall mortality. We have also analysed the records of 850 patients who had undergone renal transplantation at his institute between 1977 and 2000. Systemic fungal infections were documented in 83 (9.8 percent) patients. These included candidiasis in 25(2.8 percent). aspergillosis in 20(2.3 percent), mucormycosis in 17(20 percent) cryptococcosis in 16(1.9 percent), and rare fungi including phaehyphomycosis in 3 and histoplasmosis in 2 patients. Incidence of invasive fungal infection was found to be very high (52 percent) among the 79 autopsied renal transplant recipients. In addition our analysis showed overall incidence of 10.5 percent esophageal candidiasis in upper GI study of 89 patients. In another analysis we found evidence of fungal invasion in 21 of the 79 (26 percent) patients studied for CNS complications. To conclude fungal infections of the kidney may cause varied lesions depending upon the organism. Angioinvasive fungal infections such as aspergillosis and mucormycosis are associated with severe renal lesions and renal failure with a high morbidity and mortality. These infections may occur with increased frequency in patients with renal failure and following renal transplantation with ominous complications.
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