A patient with sarcoidosis associated with recurrent urolithiasis and tubular injury caused by calcium deposition.
A 38-year-old woman was hospitalized in January 1994 with renal dysfunction and hypercalcemia. Before admission, she was diagnosed as having urolithiasis, and had been treated twice with extracorporeal shock wave lithotripsy (ESWL). Ophthalmologically, she exhibited iritis and secondary glaucoma. Hypercalcemia, an extremely low titer of parathyroid hormone (PTH), and elevation of angiotensin-converting enzyme (ACE) and lysozyme activity were noted. These findings suggested sarcoidosis, although the chest X-ray showed only fibrotic changes. Hypercalcemia was suspected of having been caused secondarily by sarcoidosis. Since her laboratory data also showed renal dysfunction and abnormal urinalysis, a renal biopsy was performed. The histological findings indicated a tubular and interstitial disorder without glomerular abnormality; calcium deposition, which was detected by X-ray energy dispersive analysis, was observed in the tubular cytoplasm. Administration of prednisolone alleviated the renal dysfunction and decreased the elevation of ACE activity and lysozyme level of the blood. Sarcoidosis is sometimes associated with hypercalcemia, but rarely with renal dysfunction. These findings suggested that sarcoidosis may be associated with renal dysfunction due to tubular injury caused by calcium deposition in the tubules, and that glucocorticoid therapy was effective for these disorders.
Mimura
Y
Y
Third Department of Internal Medicine, Okayama University Medical School, Japan.
Maeshima
Y
Y
Ogura
T
T
Kashihara
N
N
Kawabata
K
K
Hayakawa
N
N
Nagake
Y
Y
Hironaka
K
K
Makino
H
H
Ota
Z
Z
Kageyama
J
J
D000328:Adult; D002114:Calcinosis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D006934:Hypercalcemia / Q000150:complications*; D007674:Kidney Diseases / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D007684:Kidney Tubules / Q000473:pathology*; D011239:Prednisolone / Q000627:therapeutic use; D012008:Recurrence; D012507:Sarcoidosis / Q000150:complications*; D014545:Urinary Calculi / Q000150:complications*
D005938:Glucocorticoids; D011239:Prednisolone