Acute renal failure as a form of presentation of sarcoidosis in a young adult: a case report

Abstract

IntroductionSarcoidosis is a systemic granulomatous disease. Renal involvement is a rare initial presentation of this disease. Few articles on renal involvement as an initial presentation of sarcoidosis have been published in the literature.Case presentationA 26-year-old Caucasian woman presented with acute renal failure as an initial manifestation of sarcoidosis.ConclusionsRenal involvement is an uncommon feature of sarcoidosis and it is essential to establish a fast and correct diagnosis because early therapy avoids progression to terminal renal failure.

Epidemiological, Clinical and Follow-Up Data in a Series of Thirteen Renal Insufficiencies Complicating Sarcoidosis

“…The dose and duration is variable and not codified. Recovery is more rapid and complete if the treatment was initiated at the early inflammatory stage and prior to fibrosis process [1] [9] [10]. In case of cortico-resistance, an immunosuppressor should be indicated.…”

“…The prognosis of sarcoidosis is usually good with spontaneous remission but the chronic aspect can be seen in one third of cases and may be associated then with one or more organ dysfunctions [1] [7] [9] [10]. A chronic kidney failure may be secondary to sarcoidosis especially in cases of diagnostic and therapeutic delay lateness.…”

Sarcoidosis with combined kidney damage - kidney stones, granulomatous interstitial nephritis and acute kidney injury

“…In one of the reported case a combination interstitial nephritis and membranous nephropathy was proved in patient with extrapulmonary sarcoidosis [23]. Another case report describes a patient with the history of renal colic, pulmonary-renal sarcoidisis, acute kidney injury and tubulonecrosis plus interstitial granulomas by biopsy [13]. And finally it is reported that in one patient kidney dysfunction was initially attributed to hypercalcaemia, but kidney biopsy, performed because it did not resolved after volume repletion and normalization of serum calcium level, showed nephrocalcinosis and interstitial fibrosis and a single granuloma, not significant in terms of kidney function [12].…”

“…That is confirmed by substantial recovery of kidney function, which was however incomplete because of prominent interstitial fibrosis, already existing at the time of diagnosis. We suppose that acute kidney injury on the top of chronic kidney disease both occurred due to hypercalcaemia, rather than to granulomatous interstitial nephritis [9,[11][12][13]. Kidney stones (non-obstructive and not influencing kidney function), as well as glycosuria with normal blood glucose, in combination with acidosis, likely resulted from hypercalciuria [9,11,12], which we unfortunately were unable to prove.…”

“…Obstructive uropathy is usually due to nephrolithiasis. Retroperitoneal fibrosis, retroperitoneal lymph nodes and ureteral, urethral or bladder obstruction by sarcoid involvement can also cause obstructive disease [9,13].…”