A case of renal sarcoidosis: a special reference to calcium metabolism as a diagnostic and the therapeutic implications.
Sarcoidosis is a systemic granulomatous disease of unknown etiology and is associated with a wide variety of renal disorders including nephrolithiasis, hypercalciuria, hypercalcemia, nephrocalcinosis, tubular defect, glomerulonephritis, and granulomatous interstitial nephritis. We report a case of renal sarcoidosis in which we could not detect any evidence of extrarenal involvements that was diagnosed by renal biopsy and abnormal calcium metabolism incompatible with chronic renal insufficiency. On laboratory findings, decreased creatinine clearance, proteinuria, hypercalcemia, hypercalciuria, and mildly elevated serum angiotensin-converting enzyme (ACE) were seen. Serum intact parathyroid hormone (PTH) and 1,25-dihydroxyvitamin D (1,alpha-25 vit D) were lower and higher than normal range, respectively, whereas the patient was already in chronic renal insufficiency. He was treated with oral corticosteroid. Serum ACE tended to fall, and 1,alpha-25 vit D level decreased with substantial fall of serum calcium and daily calcium excretion. In contrast, intact PTH increased slowly in accordance with a fall of serum calcium compatible with the level of renal impairment. Creatinine clearance and daily excretion of protein improved. The case reported here may propose that serial measurement of serum level of 1,alpha-25 vit D, calcium level, and magnitude of daily calcium excretion into urine is a simple and meaningful tool to detect the therapeutic response in sarcoidosis with abnormal calcium metabolism.
Mitome
Jun
J
Division of Nephrology, Kanagawa Prefectural Hospital, 1-6-5 Shiomidai, Isogo-ku, Yokohama 235-0022, Japan. mitome@jikei.ac.jp
Kawaguchi
Yoshindo
Y
Arase
Satoshi
S
Horino
Tetsuya
T
Okada
Hideo
H
Osaka
Naoyuki
N
Hanaoka
Kazushige
K
Shimada
Toshiki
T
Kawamura
Tetsuya
T
Hosoya
Tatsuo
T
Yamaguchi
Yutaka
Y
Hano
Hiroshi
H
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002118:Calcium / Q000097:blood / Q000652:urine*; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D011239:Prednisolone / Q000627:therapeutic use; D012083:Renin / Q000097:blood; D012507:Sarcoidosis / Q000175:diagnosis* / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology; D014807:Vitamin D / Q000097:blood
D000893:Anti-Inflammatory Agents; D010281:Parathyroid Hormone; D014807:Vitamin D; D011239:Prednisolone; D012083:Renin; D002118:Calcium