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Case Report Volume 14 Issue 1
Granulomatous interstitial nephritis with advanced chronic kidney disease after intravesical bacillus calmette-guérin therapy: a case report
Girin Ray, Chandra Paul Gupta, Satyaki Basu
Received: April 12, 2026 | Published: April 29, 2026
Citation: Ray G, Gupta CP, Basu S. Granulomatous interstitial nephritis with advanced chronic kidney disease after intravesical bacillus calmette-guérin therapy: a case report. Urol Nephrol Open Access J. 2026;14(1):37-41. DOI: 10.15406/unoaj.2026.14.00370
Abstract
Background: Intravesical Bacillus Calmette-Guérin (BCG) is the standard immunotherapy for high-risk non-muscle-invasive bladder cancer. Although severe renal toxicity is rare (0.1–0.4%), clinically significant chronic kidney disease (CKD) related to BCG-associated granulomatous interstitial nephritis (GIN) is likely under-recognised. Case Presentation: A female in her 60s with T1 high-grade papillary urothelial carcinoma received six weekly induction BCG instillations. Four months after completing therapy, she presented with oliguria, severe pedal oedema, and dyspnoea. Serum creatinine had risen from 0.9 mg/dL pre-BCG to 5.0 mg/dL at presentation. Renal biopsy showed non-caseating granulomatous interstitial nephritis with multinucleated giant cells, marked interstitial fibrosis (>40% cortical area), and tubular atrophy, on a background of bilaterally small, echogenic kidneys on ultrasonography, suggesting a component of chronicity. Autoimmune, vasculitic, and mycobacterial investigations were negative. BCG was stopped and the patient was managed with two hemodialysis sessions, high-dose prednisolone (40 mg/day tapered over 12 weeks), and a finite course of anti-tubercular therapy initiated empirically after multidisciplinary discussion. Renal function partially improved but stabilised at CKD Stage 4 (eGFR ~25 mL/min/1.73 m²) without dialysis dependence. Subsequently, she developed CKD-related cardiovascular abnormalities, including isolated systolic hypertension and complex arrhythmias on 24-hour Holter monitoring, consistent with CKD-associated cardiovascular dysfunction in keeping with cardiorenal interactions. Conclusion: This case illustrates presumed BCG-associated GIN with superimposed chronic tubulointerstitial damage, presenting late with advanced CKD and CKD-related cardiovascular sequelae. It underscores the importance of structured renal surveillance during and after intravesical BCG, cautious causal interpretation when chronic changes are present, and early nephrology referral for unexplained creatinine elevation. Surveillance suggestions derived from this case and existing literature should be viewed as pragmatic guidance rather than formal standards of care.
Keywords: intravesical BCG, granulomatous interstitial nephritis, chronic kidney disease, cardiorenal interactions, bladder cancer, immunotherapy complications, case report
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