Primary renal candidiasis with renal granulomata and salt-losing nephropathy

A patient is reported whose illness was characterized by chronic renal failure associated with persistent salt-wasting, chronic nephrolithiasis, and candiduria which was documented to be arising from the upper urinary tract. Intravenous amphotericin B was effective in eradicating candiduria. However, bilateral nephrectomy was ultimately performed which revealed extensive involvement of the renal parenchyma with classic caseating granulomas apparently related to renal candidiasis. Severe medullary erosion and tissue loss existed which appeared to result in disproportionate medullary destruction which was probably the most significant factor in explaining the patient's salt-losing state. The patient has since been satisfactorily managed with maintenance hemodialysis.