ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on Twitter

Kidney Week

Abstract: PO2261

An Unusual Case of Granulomatous Interstitial Nephritis (GIN)

Session Information

Category: Trainee Case Report

  • 1602 Pathology and Lab Medicine: Clinical


  • Whitney, Charis Elizabeth, University of Florida Health Science Center Jacksonville, Jacksonville, Florida, United States
  • Mars, Ronald L., University of Florida Health Science Center Jacksonville, Jacksonville, Florida, United States

A 28 Y/O man was admitted with stage 5 CKD. He was entirely asymptomatic with a negative PMH except for recent HTN & proteinuria. Entire proteinuria w/u was negative. PE was unremarkable. Kidney biopsy showed advanced glomerulosclerosis wtih chronic non-caseating GIN. Etiology was uncertain except for history of BCG vaccination. BCG induced GIN was proposed. He was given a trial of ACE-I's, but ultimately required long term hemodialysis (HD).

Case Description

A 28 Y/O Hispanic male with 1 yr PMH of untreated HTN & proteinuria presented with BUN 88, Cr 7.85. 1 day after foot surgery Cr increased to 8.14 & Renal was consulted.
1 yr ago he was diagnosed with HTN & proteinuria but never received f/u or treatment. PMH was negative. FH was significant for a cousin with ESRD s/p kidney transplant & an uncle with diabetes.
Full proteinuria w/u was (-). Renal US revealed normal size kidneys & increased cortical echogenicity c/w medical renal disease. He was started on lisinopril with improvement in BP, but no improvement in renal function & was then started on HD.
Kidney biopsy revealed acute tubular injury without regeneration changes, acute & chronic interstitial nephritis with a few granulomas, 75% global glomerulosclerosis, mild tubular atrophy & interstitial fibrosis. GMS & AFB stains were negative for fungus & mycobacteria. No electron dense deposits (EDD's) were see on electron microscopy. Further discussion with patient revealed he received BCG vaccine when 2 weeks old.


Bacillus Calmette-Guerin (BCG) vaccine is a live but attenuated strain of Mycobacterium bovis used to protect against TB in many countries with a high prevalence of TB. BCG has been implicated in the development of granulomatous disease in multiple organs, but rarely in the kidneys. Our patient received an intra-dermal BCG injection 2 wks after birth & had no sequelae or side effects. The historical (-) PMH, absence of prior medications or infectious process, (-) serologic w/u, (-) history of environmental exposures made the incidental discovery of asymptomatic stage 5 CKD with proteinuria all the more surprising.
The unexpected finding of GIN raised the consideration for stimulated immunity & granuloma formation from latent BCG vaccine. While literature documents granuloma formation in other organs, its occurrence in kidneys & potential contribution to progressive CKD seems less common, but should not to be overlooked.