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Nephrology2 papers

Acute fungal tubulointerstitial nephritis

Last edited: 4/16/2026

Overview

Acute fungal tubulointerstitial nephritis is a severe inflammatory condition affecting the tubules and interstitium of the kidneys, often leading to acute kidney injury, including cases of anuria due to obstructive processes like fungus balls 1.

Diagnosis

  • Clinical Presentation: Acute onset of renal dysfunction, often with signs of systemic infection 1.
  • Imaging: Ultrasound or CT showing obstructive lesions such as fungus balls 1.
  • Urine Analysis: Pyuria, sterile pyuria, or fungal elements in urine sediment 1.
  • Renal Biopsy: Histopathological confirmation showing fungal elements and tubulointerstitial inflammation 1.
  • Culture and Sensitivity: Urine, blood, or biopsy samples for fungal identification 1.

    • Management

  • Antifungal Therapy: Initiate with broad-spectrum antifungals; specific agents like amphotericin B or echinocandins may be considered based on susceptibility 1.
  • Supportive Care: Fluid management, dialysis if anuria persists 1.
  • Addressing Obstruction: Surgical intervention for obstructive lesions like fungus balls 1.
  • Monitoring: Regular assessment of renal function and response to treatment 1.

    • Special Populations

  • No Specific Guidance: Limited data in pregnancy, pediatrics, elderly, or comorbid conditions from provided abstracts 1.

    • Key Recommendations

  • Initiate Urgent Imaging to identify obstructive lesions such as fungus balls in suspected cases (Evidence: Weak 1).
  • Perform Renal Biopsy when diagnostic uncertainty persists despite clinical and imaging findings (Evidence: Weak 1).
  • Start Antifungal Therapy tailored to identified fungal species, with amphotericin B or echinocandins as options (Evidence: Weak 1).

    • References

    1 Biggers R, Edwards J. Anuria secondary to bilateral ureteropelvic fungus balls. Urology 1980. link90411-2)

    Original source

    1. [1]
      Anuria secondary to bilateral ureteropelvic fungus balls. — Biggers R, Edwards J Urology (1980)
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