BCG-related renal granulomas managed conservatively: A case series

Area of Science:

• Urology
• Oncology
• Pathology

Background:

• Intravesical Bacillus Calmette-Guerin (BCG) is a standard treatment for non-muscle invasive bladder cancer.
• BCG installations can potentially reach the renal pelvis, leading to upper tract complications.
• Renal granulomas are a rare but recognized complication of intravesical BCG therapy.

Purpose of the Study:

• To report two cases of incidental renal granulomas following intravesical BCG installations.
• To discuss the diagnostic approach and conservative management of these BCG-induced renal masses.
• To highlight the potential for spontaneous resolution of renal granulomas without anti-tuberculosis treatment.

Main Methods:

• Case series presentation of two patients who developed renal masses after intravesical BCG.
• Review of diagnostic workup including imaging (CT scan) and renal biopsy.
• Description of conservative management strategies and follow-up protocols.

Main Results:

• Two patients developed incidental renal masses post-BCG therapy, confirmed as non-necrotizing granulomatosis on biopsy.
• One patient's renal masses resolved completely on serial imaging without anti-tuberculosis medication.
• The second patient underwent nephroureterectomy for urothelial carcinoma, with incidental findings of BCG-related renal granulomatosis, and remained asymptomatic without specific treatment.

Conclusions:

• Intravesical BCG can lead to renal granulomas, which may be incidentally discovered on imaging.
• Renal biopsy is recommended for incidental renal masses in patients with a history of intravesical BCG.
• BCG-related renal granulomas can exhibit spontaneous resolution and may not require anti-tuberculosis medication.