Varanasi, Paavana

ABSTRACT Background Intravesical Bacillus Calmette–Guerin (BCG) is a live attenuated vaccine for tuberculosis. Intravesical BCG (iBCG) administration is a highly effective immunotherapy for non‐muscle invasive bladder cancer (NMIBC). Although live attenuated vaccines are generally contraindicated in solid organ transplant recipients (SOTR), iBCG has been utilized for NMIBC in SOTR. We describe the clinical manifestations, management, and outcomes of disseminated Mycobacterium bovis ‐BCG infection (Mb‐BCGi) following iBCG therapy in SOTR for NMIBC. Methods All adult patients (> 18 years of age) diagnosed with NMIBC who received iBCG across three tertiary referral and transplant centers between 2000 and 2025 were identified. The study cohort consisted of SOTR who had received iBCG for NMIBC and subsequently developed disseminated Mb‐BCGi. English language literature review was performed to identify additional cases. Results A total of 4207 patients received iBCG during the study period. Thirty (0.71%) were SOTR, of whom two (6.7%) developed disseminated Mb‐BCGi, including bloodstream infection and prostate abscesses. Literature review identified two additional disseminated Mb‐BCGi cases in SOTR with lungs, bloodstream, and native kidney involvement, and one fatality. All cases required extended antimycobacterial therapy. Median times from SOT to Mb‐BCGi and from iBCG to Mb‐BCGi were 104 and 8 months, respectively. Conclusion SOTR appear to be at a higher risk of disseminated Mb‐BCGi following iBCG. Administration of iBCG in SOTR with NMIBC warrants careful risk‐benefit assessment and subsequent close monitoring. image

Point-of-care ultrasonography (POCUS) is emerging as a valuable tool in nephrology, providing real-time insights into the etiology of acute kidney injury (AKI). This narrative review explores POCUS applications in AKI, emphasizing its role in diagnostic kidney ultrasound and comprehensive hemodynamic assessments. AKI, prevalent in hospitalized patients, poses significant morbidity and mortality risks. POCUS aids in unraveling AKI’s multifaceted origins, categorizing it into hemodynamic, obstructive, and intrinsic renal causes. We discuss the utility of POCUS in urinary obstruction by identifying hydronephrosis and detecting stones and providing prompt diagnostic assistance. In intrinsic AKI, POCUS has limited utility but can potentially differentiate between acute and chronic kidney disease and identify infectious complications. POCUS-assisted hemodynamic AKI assessment involves thorough evaluation of the cardiac, lung, and end organ venous congestion. As technology advances, the role of POCUS in the diagnosis and management of AKI is likely to increase, offering a portable, cost-effective, and radiation-free bedside diagnostic modality. This also has the potential to improve patient outcomes. However, proper training in techniques of POCUS and an understanding of the limitations of POCUS are essential elements in ensuring its optimal and appropriate use in the right clinical context.