Abstract: TH-PO943
IgA Nephropathy Associated with Intravesical Bacillus Calmette-Guerin: A Case Report
Session Information
- Glomerular Trainee Case Reports
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Report
- 1202 Glomerular Diseases: Immunology and Inflammation
Authors
- Alexander, Kyrstin, UMASS Memorial Renal Medicine, Worcester, Massachusetts, United States
- Vanguri, Vijay, University of Massachusetts Medical School, Worcester, Massachusetts, United States
- Ralto, Kenneth M., University of Massachusetts Medical School, Worcester, Massachusetts, United States
Introduction
BCG immunotherapy has remained crucial in the treatment of non-muscle invasive bladder cancer. Serious systemic complications can occur including granulomatous inflammation in various organs (BCGosis), reactive arthritis, and disseminated BCG. We present a unique case of BCGosis associated with new onset IgA nephropathy (IgAN).
Case Description
A 79 year-old man with type 2 diabetes, chronic kidney disease stage 3A received intravesical BCG therapy two months prior to presentation and developed caseating granulomas of the liver thought secondary to Mycobacterium bovis abdominal infection. He subsequently presented with altered mental status, dyspnea, abdominal pain, and acute kidney injury two weeks after starting antitubercular therapy. RIPE therapy was discontinued, however his creatinine continued to rise. He developed uremic symptoms with a creatinine peaking at 4.0 mg/dL, nephrotic-range proteinuria and an active urine sediment with many dysmorphic RBCs and mixed cellular cell casts. Prednisone 50 mg daily was started, and a kidney biopsy was arranged. Serologic evaluation was unremarkable and complement levels were normal. Renal biopsy showed focally crescentic IgAN with acute tubular injury and focal necrosis (Figure). He was continued on a prolonged steroid taper and lisinopril was started. After several months his creatinine had improved to 2.70 mg/dL.
Discussion
This is the first reported case of IgAN associated with intravesical BCG therapy. Treatment is challenging given the need to balance immune suppression with antitubercular treatment. BCGosis is a rare but serious complication of BCG therapy and has been associated with other renal pathology including granulomatous interstitial nephritis, Henoch Schönlein purpura and membranous nephropathy.