BCG
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Acute renal failure due to interstitial nephritis following intravesical instillation in an elderly patient: case report A 76-year-old man developed acute renal failure due to interstitial nephritis following intravesical instillation of BCG [dosage not stated] for bladder cancer. The man started receiving BCG instillations, once a week for 6 weeks. From May to October 2004, he received four cycles of BCG [duration of treatment not clearly stated]. One month after his last cycle, he was hospitalised with progressive asthenia and anorexia. Laboratory investigations revealed the following: haemoglobin 14.5 g/dL, WBC count 11 160 /mm3, serum sodium 141 mEq/L, potassium 4.3 mEq/L and serum creatinine 6.58 mg/dL. Urinary sediment analysis revealed 10–15 leucocytes/high-power field. Urine samples showed persistent eosinophiluria. A renal biopsy showed diffuse and severe interstitial cellular infiltrate consisting of plasma cells, lymphocytes and eosinophils. Benign hypertensive nephrosclerosis was observed and 1 out of 12 glomeruli showed global sclerosis. He was diagnosed with acute interstitial nephritis superimposed on previous mild chronic nephrosclerosis. The man received methylprednisolone, followed by prednisone, which was tapered over the next 4 months. BCG instillations were discontinued. His serum creatinine level gradually decreased to between 3 and 3.5 mg/dL without further improvement. A second renal biopsy revealed that the previous interstitial cellular infiltrates were replaced by fibrotic tissue and only isolated areas of interstitial infiltrates of lymphocytes and plasma cells were present. One year later, he had a serum creatinine level of 4.03 mg/dL and a creatinine clearance of 20 mL/min. He had a urinary protein excretion of 0.58 g/day with normal urinary sediment. Manzanera Escribano MJ, et al. Acute renal failure due to interstitial nephritis after intravesical instillation of BCG. Clinical and Experimental Nephrology 11: 801079220 238-240, No. 3, Sep 2007 - Spain
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Reactions 3 Nov 2007 No. 1176
