Henoch Schönlein Purpura Nephritis Associated with Intravesical Bacillus Calmette-Guerin (BCG) Therapy

Tsukada, Hiroyuki; Miyakawa, Hiroshi

doi:10.2169/internalmedicine.56.7494

Cited by 16 publications

(10 citation statements)

References 7 publications

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“…Intravesical BCG vaccine administration has also been associated with autoimmune diseases such as Henoch-Schoenlein pupura and Guillain Barre syndrome. [137][138][139][140] In experimental models BCG can accelerate autoimmune diseases. 141 Cases of endophthalmitis, uveitis, vitiligo, meningitis, aortitis, or mycotic aneurysms have been reported as well as central nervous system vasculitis.…”

Section: Complications Of Bcg Immunizationmentioning

confidence: 99%

BCG: a vaccine with multiple faces

Yamazaki‐Nakashimada

Unzueta

Gámez-González

et al. 2020

Human Vaccines & Immunotherapeutics

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BCG has been recommended because of its efficacy against disseminated and meningeal tuberculosis. The BCG vaccine has other mechanisms of action besides tuberculosis protection, with immunomodulatory properties that are now being discovered. Reports have shown a significant protective effect against leprosy. Randomized controlled trials suggest that BCG vaccine has beneficial heterologous (nonspecific) effects on mortality in some developing countries. BCG immunotherapy is considered the gold standard adjuvant treatment for non-muscle-invasive bladder cancer. BCG vaccine has also been tested as treatment for diabetes and multiple sclerosis. Erythema of the BCG site is recognized as a clinical clue in Kawasaki disease. BCG administration in the immunodeficient patient is associated with local BCG disease (BCGitis) or disseminated BCG disease (BCGosis) with fatal consequences. BCG administration has been associated with the development of autoimmunity. We present a brief review of the diverse facets of the vaccine, with the discovery of its new modes of action providing new perspectives on this old, multifaceted and controversial vaccine.

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Section: Complications Of Bcg Immunizationmentioning

confidence: 99%

BCG: a vaccine with multiple faces

Yamazaki‐Nakashimada

Unzueta

Gámez-González

et al. 2020

Human Vaccines & Immunotherapeutics

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“…It responded well to steroids and ATT. Another case from Japan recently reported RPGN with fatal outcome in an elderly male [ 17 ]. Importance of history of recent IVBCG use was emphasised as well as fatal infection risk following immunosuppression and plasma exchange amongst elderly.…”

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%

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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“…In these cases, the therapy with glucocorticoids was administered and in three out of eight patients the renal function recovered [144][145][146]. The other single cases include nephritis in the course of Henoch Schönlein Purpura [147] and membranous glomerulonephritis with clinical presentation of nephrotic syndrome [148]. It is worth mentioning that during follow-up after the intravesical BCG therapy some asymptomatic kidney lesions may be found in the imaging diagnosis, which may turn out to be kidney granulomas.…”

Section: Renal Adverse Effectsmentioning

confidence: 98%

Adverse Renal Effects of Anticancer Immunotherapy: A Review

Borówka¹,

Łącki-Zynzeling²,

Nicze³

et al. 2022

Preprint

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Modern oncological therapy utilizes various types of immunotherapy. Immune checkpoint inhib-itors (ICIs), chimeric antigen receptor T cells (CAR-T) therapy, cancer vaccines and bispecific an-tibodies are improving patients’ outcomes. However, stimulation of the immune system, benefi-cial in terms of fighting against cancer, generates the risk of harm to other cells in a patient's body. Kidney damage belongs to the relatively rare adverse events (AEs). Best described, but still, su-perficially, are renal AEs in patients treated with ICIs. International guidelines issued by Euro-pean Society for Medical Oncology (ESMO) and American Society of Clinical Oncology (ASCO) cover the management of immune-related adverse events (irAEs) during ICI therapy. There are scarce data concerning renal adverse drug reactions of other immunotherapeutic methods. This implicates the need for the collection of safety data during ongoing clinical trials and in the re-al-life world to characterize the hazard related to the use of new immunotherapies and manage-ment of irAEs.

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Henoch Schönlein Purpura Nephritis Associated with Intravesical Bacillus Calmette-Guerin (BCG) Therapy

Cited by 16 publications

References 7 publications

BCG: a vaccine with multiple faces

BCG: a vaccine with multiple faces

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

Adverse Renal Effects of Anticancer Immunotherapy: A Review

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