Neonatal urinary ascites in renal candidal infection

A preterm neonate developed anuria and abdominal distension. Peritoneal fluid contained high levels of potassium, urea and creatinine with a low level of bicarbonate compared with plasma. Renal ultrasound showed dilatation of the left collecting system with echogenic material in the calyces bilaterally, which together with positive cultures of candida from blood, urine and peritoneal fluid suggested renal candidiasis with obstruction. Computed tomography (CT) showed extravasation around the right kidney on delayed post contrast films, confirming that the peritoneal fluid was urine. The patient improved rapidly after insertion of the peritoneal drain and made a full recovery with antifungal agents and a left nephrostomy. Causes of urinary ascites are discussed and characteristic biochemical features described. Ultrasound and contrast CT may be diagnostic and help to monitor progress.