A Case of Renal Failure associated with Sarcoidosis

• Published in: The Japanese Journal of Nephrology Vol. 16; no. 9; pp. 877 - 886
• Main Authors: Tofuku, Yohei, Ueno, Toshio, Kito, Chikashi, Kuroda, Mitsuhiko
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society of Nephrology 30-09-1974
• ISSN: 0385-2385; 1884-0728
• DOI: 10.14842/jpnjnephrol1959.16.877

A 24 year-old female patient with renal failure associated with sarcoidosis was reported. Diagnosis for sarcoidosis was based on the findings such as BHL on chest roentgenogram, turbidity of the retina, positive for Kveim test, epithelioid granuloma in the biopsy specimen from her leg nodule, high ESR, hypergamm-aglobulinemia and hypercalcemia. Other laboratory data disclosed mild renal insufficiency ; mild proteinuria, elevation of BUN and serum creatinine, and decreased GFR and RPF. X-ray examination of the kidney showed large kidneys with irregular contour, but without nephrocalcinosis. Renal scintigram showed many coin-like lesions bilaterally. Histologic examination of renal biopsy specimen revealed severe interstitial nephritis with hyaline necrosis, but without calcium deposition. It is reasonable to pressume that renal failure was due to the involvement of sarcoid granulomata to the kidney, although neither epithelioid nor giant cells could be found out in the renal biopsy specimen. Porcine calcitonin was administered prior to corticoid therapy which improved her general conditions. Calcitonin was effective to lower serum calcium and inorganic phosphate levels. Of particular interest was the decrease of urinary phosphate excretion as well as calcium excretion, despite of constant urine volume and creatinine clearance during calcitonin administration. Hypercalcemia in this case was assumed to be due to the increased state of bone resorption.