An autopsy series of 42 patients who had visceral candidiasis was studied to determine the incidence and clinicopathologic features of Candida-associated renal papillary necrosis. Papillary necrosis was found in nine patients (21%), associated in all instances with fungal invasion of the kidney. The single most common associated condition was prematurity, present in three neonates, and antibiotic or immunosuppressive therapy was a contributing factor in most instances. The clinical significance of candidal papillary necrosis is unclear because most patients had other causes of renal failure. Antemortem diagnosis is exceptionally difficult and had not been made in any of these patients. Pyelograms have aided in the diagnosis in only one well-documented case in the literature. This study shows that the pathologic features of candidal renal papillary necrosis correlate well with the findings in experimentally induced disease, and that this lesion appears to be more common than previously suspected.