Seltene Ursache für ein postrenales Nierenversagen

Zusammenfassung

Anamnese und klinischer Befund Der folgende Case Report berichtet über die Aufnahme eines Patienten mit einem akut auf chronischen Nierenversagen unter BCG-(Bacillus-Calmette-Guérin)-Erhaltungstherapie bei bekanntem Blasenkarzinom mit sonografisch dargestelltem Harnstau II.–III. Grades ohne Restharn. Die zystoskopisch nachweisbare beidseitige intramurale Engstelle kann im Rahmen der BCG-Therapie gedeutet werden.

Therapie und Verlauf Es folgte die Anlage einer Doppel-J-Schiene, worunter sich die Nierenretentions-Parameter schnell besserten.

Folgerung Ein postrenales Nierenversagen ist mit 5 % eher selten, wobei in der differenzialdiagnostischen Überlegung neben anderen Ursachen auch eine medikamentös-induzierte Ursache (z. B. BCG) einzubeziehen ist.

Abstract

History and clinical findings In the following case report, we describe a patient with acute renal failure due to an urinary congestion level II-III under BCG-(Bacillus Calmette-Guérin)-therapy because of bladder cancer. Cystoscopy revealed the diagnosis of BCG-induced intramural narrowing of distal ureters bilaterally.

Therapy and further development After receiving a double-J-catheter the renal function returned to normal.

Conclusions Although postrenal failure is relatively rare (5 %), also seldom causes such as medication-induced (e. g. BCG) ureter stenosis has to be included into the differential diagnosis.

Schlüsselwörter

Nierenversagen - Blasenkarzinom - Stauungsniere - BCG-Therapie

Key words

acute renal failure - bladder Cancer - BCG therapy

Publication History

Article published online:
28 March 2022

• Literatur

• 1 Brady HR, Singer GG. Acute renal failure. Lancet 1995; 346: 1533-1540
• 2 Thadhani R, Pascual M, Bonventre JV. Acute renal failure. N Engl J Med 1996; 334: 1448-1460
• 3 Böhle A, Brandau S. Immune mechanisms in bacillus Calmette-Guerin immunotherapy for superficial bladder cancer. J Urol 2003; 170 (03) 964
• 4 Dahm P, Gschwend JE. Malignant non-urothelial neoplasms of the urinary bladder: a review SO Eur Urol. 2003; 44 (06) 672
• 5 Fachinformation Medoc, Internetquelle. https://s3.eu-central-1.amazonaws.com/prod-cerebro-ifap/media_all/98021.pdf
• 6 Sylvester RJ. et al. Bacillus calmette-guerin versus chemotherapy for the intravesical treatment of patients with carcinoma in situ of the bladder: a meta-analysis of the published results of randomized clinical trials. J Urol 2005; 174 (01) 86
• 7 Kassouf W. et al Treatment of primary non-muscle invasive urothelial bladder cancer. Literature review current through: Apr 2021. This topic last updated: Mar 25, 2021
• 8 Schwalb HW. et al. Intravesical bacillus Calmette-Guérin therapy prevents tumor progression and death from superficial bladder cancer: ten-year follow-up of a prospective randomized trial. J Clin Oncol 1995; 13 (06) 1404
• 9 Larsen ES, Joensen UN, Poulsen AM. et al. Bacillus Calmette-Guérin immunotherapy for bladder cancer: a review of immunological aspects, clinical effects and BCG infections. APMIS 2020; 128: 92
• 10 Green DB, Kawashima A, Menias CO. et al. Complications of Intravesical BCG Immunotherapy for Bladder Cancer. Radiographics 2019; 39: 80
• 11 Liu Y, Lu J, Huang Y. et al. Clinical Spectrum of Complications Induced by Intravesical Immunotherapy of Bacillus Calmette-Guérin for Bladder Cancer. Journal of Oncology 2019; 1-11
• 12 Lamm DL. Efficacy and safety of bacille Calmette-Gu’erin immunotherapy in superficial bladder cancer. Clinical Infectious Diseases 2000; 31 (Suppl. 03) S86-S90
• 13 Kaneko T, Fujita K, Homma Y. Transient anuria requiring nephrostomy after intravesical bacillus Calmette-Gu’erin instillations for superficial bladder cancer. International Journal of Urology 2006; vol. 13, no. 3: 294-295
• 14 Mody GN, Tran V, Landman J. BCGosis: Case Report of Intravesicular Bacille Calmette-Guérin Causing Upper Tract Granulomas Simulating a Renal Mass Without Evidence of Ipsilateral Vesicoureteral Reflux. Urology 2009; 73 (02) 444.e9-444.e10