NEWSLETTER

Rare Case of Renal Sarcoidosis

Need to Know About Kidney disease : Rare Case of Renal Sarcoidosis

SARCOIDOSIS:

Sarcoidosis is a multisystem inflammatory disease characterized by the presence of non-caseating granulomas. Although sarcoidosis can virtually affect any organ in the body, the lung is the most common organ affected followed by the liver, skin, and eye.

Etiology:

Despite multiple investigations, the etiology was unclear. Currently, the most likely etiology is an infectious or noninfectious environmental agent that triggers an inflammatory response in a genetically susceptible host.

RENAL MANIFESTATIONS OF SARCOIDOSIS:

  • CALCIUM DYSREGULATION
  • HYPERCALCIURIA
  • HYPERCALCEMIA
  • OBSTRUCTIVE UROPATHY
  • RETROPERITONEAL FIBROSIS & LYMPHADENOPATHY
  • TUBULOINTERSTITIAL DISEASE
  • GRANULOMATOUS INTERSTITIAL NEPHRITIS
  • NON-GRANULOMATOUS INTERSTITIAL NEPHRITIS
  • GLOMERULAR DISEASE(RARE) Pathophysiology

Clinically apparent renal involvement is considered rare, occurs in less than 5% of sarcoidosis patients, usually associated with granulomas in the kidney itself, and can lead to nephritis. However, hypercalcemia is the most likely cause of sarcoidosis-related renal disease. The cause for hypercalcemia is 1 -hydroxylation of 25(OH) vitamin D to form 1,25 (OH)2 vitamin D in the macrophages of sarcoid granulomas. Usually, treatment with corticosteroids shows a good response but relapses are frequent particularly while tapering steroids. Patients who are steroid intolerant/steroid-resistant are treated with cyclophosphamide, infliximab, azathioprine, and mycophenolate mofetil. Rarely sarcoidosis may lead to end-stage renal disease.

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