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.
Ohashi
Naro
N
First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu.
Yonemura
Katsuhiko
K
Hirano
Manae
M
Takahashi
Satoru
S
Kato
Akihiko
A
Fujigaki
Yoshihide
Y
Yamamoto
Tatsuo
T
Hishida
Akira
A
D058186:Acute Kidney Injury / Q000188:drug therapy / Q000209:etiology* / Q000378:metabolism; D000328:Adult; D000596:Amino Acids / Q000652:urine; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001842:Bone and Bones / Q000378:metabolism; D002117:Calcitriol / Q000097:blood; D002118:Calcium / Q000097:blood; D005260:Female; D006099:Granuloma / Q000150:complications*; D006801:Humans; D006934:Hypercalcemia / Q000150:complications*; D009395:Nephritis, Interstitial / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism; D015675:Osteocalcin / Q000097:blood; D011239:Prednisolone / Q000627:therapeutic use; D012507:Sarcoidosis / Q000150:complications* / Q000378:metabolism
D000596:Amino Acids; D000893:Anti-Inflammatory Agents; D015675:Osteocalcin; C036020:deoxypyridinoline; D011239:Prednisolone; D002117:Calcitriol; D002118:Calcium