Candida species are unusual causes of urinary tract infection (UTI) in healthy individuals, but common in the
hospital setting or among patients with predisposing diseases and structural abnormalities of the kidney and
collecting system. The urinary tract may be invaded in either an antegrade fashion from the bloodstream or
retrograde via the urethra and bladder. Candida species employ a repertoire of virulence factors, including
phenotypic switching, dimorphism, galvano - and thigmotropism, and hydrolytic enzymes, to colonize and then
invade the urinary tract. Antegrade infection occurs primarily among patients predisposed to candidemia. The
process of adherence to and invasion of the glomerulus, renal blood vessels, and renal tubules by Candida
species was elegantly described in early histopathologic studies. Armed with modern molecular biologic
techniques, the various virulence factors involved in bloodborne infection of the kidney are gradually being
elucidated. Disturbances of urine flow, whether congenital or acquired, instrumentation of the urinary tract,
diabetes mellitus, antimicrobial therapy, and immunosuppression underlie most instances of retrograde
Candida UTI. In addition, bacterial UTIs caused by Enterobacteriaceae may facilitate the initial step in the
process. Ascending infections generally do not result in candidemia in the absence of obstruction
