Kidney Week

Abstract: SA-PO0359

Fungal Ball-Istics: Clearing the Fog with Point-of-Care Ultrasonography (POCUS)

Session Information

• AKI: Case Reports - Drug/Toxin Injury, Crystals, Obstruction, and Unusual Presentations
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Qinami, Blerta, SBH Health System, New York, New York, United States

Blerta Qinami, MD

• Achamyeleh, Yohannes, SBH Health System, New York, New York, United States

Yohannes Achamyeleh, MD

• Salvador, Tania E., SBH Health System, New York, New York, United States

Tania E. Salvador, MD

• Cobaj, Ardijan, SBH Health System, New York, New York, United States

Ardijan Cobaj, MD

• Flores Chang, Bessy Suyin, SBH Health System, New York, New York, United States

Bessy Suyin Flores Chang, MD, FASN

• Broka, Andrea, SBH Health System, New York, New York, United States

Andrea Broka, MD

Introduction

A fungus ball in the urinary tract, mainly occurring in immunocompromised patients, is a rare and dangerous complication of candiduria.Obstructive uropathy secondary to fungal balls can have significant implications, with the potential for severe hydronephrosis, renal damage, and progression to life-threatening sepsis; however it may remain unrecognized.

Case Description

A 55-year-old man with diabetes presented to the ED with weakness, nausea, chills, dysuria, and oliguria. He had bilateral costovertebral angle and lower abdominal tenderness, leukocytosis, and acute kidney injury with creatinine rising to 7.2 mg/dL from a baseline of 1.0 mg/dL. Urinalysis with concern for UTI showed moderate bacteria and few budding yeast.The nephrology team performed POCUS, which revealed a distended bladder, moderate bilateral hydronephrosis (left greater than right), and echogenic debris within the left renal pelvis and bladder, findings raising concern for obstructive uropathy with possible fungal disease. Foley catheter placement yielded grossly purulent urine, and repeated catheter obstruction by purulent material necessitated frequent irrigation for several days.Empiric antibiotic therapy was initiated with additional fluconazol, final urine cultures grew Enterococcus faecalis and Candida albicans.Serial POCUS exams demonstrated resolution of hydronephrosis and the fungus ball following the treatment with antifungal therapy.

Discussion

POCUS is an important adjunct to the physical exam, providing real-time data that expands the differential diagnosis and facilitates early management. This case highlights the critical role of POCUS in guiding targeted management, ensuring timely and appropriate therapy and reducing the risk of systemic decompensation. It is also particularly useful for serial assessments, as demonstrated in this case of recurrent Foley obstruction due to significant debris, where POCUS enabled effective monitoring of disease progression. Its accessibility and clinical utility support broader integration into nephrology practice and training.