BCG-Related Renal Granulomas Managed Conservatively

Al‐Qaoud, Talal; Brimo, Fadi; Aprikian, Armen; Andonian, Sero

doi:10.5489/cuaj.2664

Cited by 21 publications

(15 citation statements)

References 25 publications

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“…A hypovascular renal mass may be found by contrast-enhanced CT. Given the fact that post-TUR vesicoureteral reflux has been shown in up to 77% of patients with resection close to the ureteral orifice, the mechanism of renal BCG infections is more likely to be related to reflux of the intravesical BCG rather than hematogenous spread [ 41 ]. Renal biopsies can help to establish histopathological diagnosis based on epithelioid cell granulomas; however, acid-fast bacilli may not be present.…”

Section: Genitourinary Complicationsmentioning

confidence: 99%

Clinical Spectrum of Complications Induced by Intravesical Immunotherapy of Bacillus Calmette-Guérin for Bladder Cancer

Liu

Huang

et al. 2019

Journal of Oncology

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Because of its proven efficacy, intravesical Bacillus Calmette-Guérin (BCG) immunotherapy is an important treatment for nonmuscle invasive bladder cancer at high risk of recurrence or progression. However, approximately 8% of patients have to stop BCG instillation as a result of its complications. Complications induced by BCG therapy can have a variety of clinical manifestations. These adverse reactions may occur in conjunction with BCG instillation or may not develop until months or years after BCG cessation. An essential step in the management complications arising from BCG is early establishment of diagnosis, particularly for distant, disseminated, and obscure infections. Therefore we reviewed the literature on the potential complications after intravesical BCG immunotherapy for bladder cancer and provide an overview on the incidence, diagnosis, and treatment modality of genitourinary and systemic BCG-induced complications.

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Section: Genitourinary Complicationsmentioning

confidence: 99%

Clinical Spectrum of Complications Induced by Intravesical Immunotherapy of Bacillus Calmette-Guérin for Bladder Cancer

Liu

Huang

et al. 2019

Journal of Oncology

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“…Two patients developed abscess which was drained, no fistula formation was seen. Although spontaneous resolution of biopsy-proven renal granuloma has been reported [33], corticosteroids and antimycobacterial agents are the preferred remedies for these lesions. Nephrectomy or nephroureterectomy is the definitive remedy for patients who have non manageable fever or soreness despite the medicinal therapy [34].…”

Section: Discussionmentioning

confidence: 99%

Complications of intravesical BCG therapy in non-muscle invasive bladder cancer: our tertiary care centre experience

et al. 2020

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Background Urothelial bladder carcinoma accounts for around 3.9% cases of all the male cancers in India. Non-muscle-invasive bladder carcinoma (NMIBC) is predominant group which constitute approximately three fourth of the urothelial bladder cancer. Intravesical BCG immunotherapy is the corner stone of today’s NMIBC management. However, as with any other therapy it has its own complications and its interruption due to these adverse effects is a major cause of suboptimal efficacy. The aim of this study was to assess the complications of intravesical BCG therapy and their management in NMIBC patients. Methods This was a retrospective descriptive study conducted between October 2016 and November 2019; a backward review of 149 patients with diagnosis of NMIBC that undergone intravesicle BCG therapy was performed. Patient’s demographical, clinical, diagnostic and procedural data regarding bladder tumour, BCG therapy, its complications and management were collected and analysed. Results Total 149 patients were analysed, comprising 116 males and 33 females. The mean age was of 57.2 ± 6.7 years. Total 85.23% were primary and 14.76% were recurrent tumours. Total 96 patients (64.42%) completed the planned course, while 53 (35.57%) interrupted. The reasons for BCG interruption includes adverse effects (15.4%), progression of disease (6.7%), disease refractory to BCG (4.6%) and disease recurrence during BCG (3.3%). Most of the adverse events occurred in first 6 months and most interruptions occurred after the induction period. Cystitis was the most common observed adverse effect seen in 39.6% patients. Frequency, urgency, haematuria were common presentation. Radical cystectomy was the most common (16.10%) further treatment with patients whose treatment was interrupted. Conclusion BCG is an indispensable therapy available for NMIBC, but it is associated with array of adverse effects and complications, which are the main reasons for poor compliance to BCG therapy. Although BCG-related complications can affect any organ in the body, potentially life-threatening systemic BCG-related infections are encountered in only < 5% of patients. There are some difficulties in diagnosis of the BCG complications because acid-fast staining, culture and PCR test are not always positive; tissue biopsies should be indicated sometimes to evaluate histopathology and presence of M. bovis. A persistently monitored multidisciplinary approach with high index of suspicion and prompt anti-TB therapy can help to derive the maximum benefits while keeping the complications at check.

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“…Granuloma resolved with Anti-Tuberculous therapy (ATT) in one case and required nephro-ureterectomy in another due to left renal pelvic tumour. However, recent case series managed conservatively for 2 years showed no systemic features or progression [ 15 , 16 ]. AKI due to interstitial nephritis with/without granuloma ( n = 8): This is the commonest presentation reported with elevated serum creatinine levels.…”

Section: Discussionmentioning

confidence: 99%

“… 12 Membranous glomerulonephritis - IgM, C3 and IgG+ No Pred alone Complete Remission Normal 2013 [ 12 ] 76 M AKI 7.9 ? 10 Tubulointerstitial nephritis with moderate eosinophilic infiltrate No Oral MP, ATT, HD Partial Off HD; 2.5 2015 [ 15 ] 52 M Surveillance CT 1.2 Onco Tice 18 Necrotising granuloma with no interstitial inflammation; IF not done; Yes ATT Complete 1.2 2015 [ 16 ] 68 M VH – OncoTice 18 Non-necrotising granulomas Yes None Complete – 2015 [ 16 ] 74 M NVH – OncoTice 9 Chronic Granulomatous Interstitial Nephritis Yes None Complete – 2017 [ 17 ] 80 M AKI-RPGN HSP 3.6 Connaught 8 IgA-Fibrinoid necrosis + 20% crescents Mesangial IgA. Skin- HSP vasculitis No MP, Pred Pl.Ex, HD Partial Died Off HD; 2.8 Present 73 F Advanced CKD5 4 OncoTice 16 Interstitial nephritis with granuloma and acute/chronic tubular damage, IF negative Yes Pred alone ...…”

Section: Discussionmentioning

confidence: 99%

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Emerging concepts and spectrum of renal injury following Intravesical BCG for non-muscle invasive bladder cancer

Mohammed

Arastu

2017

BMC Urol

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BackgroundIntravesical Bacilli Calmette-Guerin (IVBCG) therapy for non-muscle invasive bladder cancer (NMIBC) has long been in use successfully. Albeit rarely, we still face with its safety concerns more than 25 years on since its approval by US Food and Drug Agency in 1990. Local and systemic infection following intravesical BCG is widely reported as compared to immune mediated local or systemic hypersensitivity reactions involving kidneys; acute kidney injury (AKI) and other renal manifestations are well reported but not of chronic kidney disease (CKD).CaseAn interesting case of a female was referred to nephrologists in advanced stages of CKD at an eGFR of 10 ml/min/1.732 following IVBCG for NMIBC. Our patient’s renal function plateaued when IVBCG was held; and worsened again when reinstilled. It introduces the concept of ‘repetitive’ immune mediated renal injury presenting as progressive CKD rather than AKI, as is generally reported. Although response was poor, corticosteroids stopped CKD progression to end stage renal disease.ConclusionsWe highlight the need for increased awareness and early recognition of IVBCG renal complications by both urologists and nephrologists in order to prevent progressive and irreversible renal damage. Low incidence of IVBCG renal complications may also be due to under recognition in the era prior to CKD Staging and AKI Network (and AKI e-alerts) that defined AKI as a rise in serum creatinine of ≥26umol/L; hence an unmet need for urgent prospective studies. Major literature review focuses on emerging spectrum of histopathological IVBCG related renal complications and their outcomes.

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BCG-Related Renal Granulomas Managed Conservatively

Cited by 21 publications

References 25 publications

Clinical Spectrum of Complications Induced by Intravesical Immunotherapy of Bacillus Calmette-Guérin for Bladder Cancer

Clinical Spectrum of Complications Induced by Intravesical Immunotherapy of Bacillus Calmette-Guérin for Bladder Cancer

Complications of intravesical BCG therapy in non-muscle invasive bladder cancer: our tertiary care centre experience

Emerging concepts and spectrum of renal injury following Intravesical BCG for non-muscle invasive bladder cancer

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