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A patient with sarcoidosis presenting with acute renal failure: implication for granulomatous interstitial nephritis and hypercalcemia.

A woman was admitted for acute renal failure and erythematous lesions. She was diagnosed with sarcoidosis after analysis of biopsy specimens revealed noncaseating epithelioid granulomas, elevated serum angiotensin-converting enzyme levels, and bilateral hilar lymphadenopathy. Serum concentrations of ionized calcium and 1,25-dihydroxyvitamin D3 [1,25-(OH)2D3] were extremely high. Serum intact osteocalcin concentration and urinary deoxypyridinoline excretion were within reference ranges. Treatment with prednisolone induced a prompt improvement with normalization of serum concentrations of ionized calcium and 1,25-(OH)2D3. Serum intact osteocalcin concentration was markedly suppressed and urinary deoxypyridinoline excretion increased. It is possible suppressed bone resorption may be associated with overproduction of 1,25-(OH)2D3.

Acute Kidney Injury↗

[A case of sarcoidosis with renal failure as the main manifestation in granulomatous interstitial nephritis].

A 39-year-old woman was consulted to our hospital because of renal failure on October 1992. A chest X-ray showed no abnormal shadow. Subsequently, she was under conservative treatment until December 1993, when she began to notice clouded vision. The iridocyclitis in both eyes was diagnosed by a ophthalmologist. She was admitted to our hospital for the purpose of a renal biopsy. Laboratory tests revealed renal failure: a creatinine clearance of 24.5 ml/min, a serum level of creatinine of 3.2 mg/ml and blood urea nitrogen of 38.7 mg/dl. The angiotensin converting enzyme was 17.6 IU/ml (normal 8.3 approximately 21.4 IU/ml), but lysozyme was 49.5 micrograms/ml (normal 5.0 approximately 10.2). Mantoux's reaction was negative. 57Ga scintigram showed abnormal uptakes on eyes, bilateral salivary gland, both thighs, both kidneys, and in a part of lung field. A percutaneous renal biopsy revealed non-caseating histiocytic granulomas with diffuse infiltration of lymphocytes and neutrophils into interstitium. Glomeruli were ischemic and mild endocapillary proliferations with pericapsular fibrosis were seen. Both of transbronchial lung biopsy (TBLB) and skin biopsy also revealed non-caseating histiocytic granulomas. Oral administration of prednisolone, 40 mg/day, improved the level of serum creatinine and lysozyme. Sarcoidosis is a granulomatous disease of unknown etiology that may involve any organ or tissue of the body. The clinical picture dominating in adults is the one with pulmonary and mediastinal lymph node involvement, eye and skin lesions. Although the renal involvement were rarely encountered, the present case showed that the renal failure was one of the most important clinical feature in patient with sarcoidosis.

Adult↗

Recurrent acute renal failure with interstitial nephritis due to D-penicillamine.

A 60-year-old man with rheumatoid arthritis, who developed acute reversible renal failure with nephrotic syndrome and tubulointerstitial nephritis in association with multiple-drug therapy, is described. The episode was ascribed to the nonsteroidal anti-inflammatory agent fenbufen, and the patient was reexposed to D-penicillamine within 6 months, reproducing the same renal lesion. There was no evidence of the glomerular lesions characteristically associated with D-penicillamine nephrotoxicity. D-penicillamine was the only drug therapy common to both episodes and it is concluded that it may cause tubulointerstitial nephritis with nephrotic syndrome.

Acute Kidney Injury↗