Angiotensin-I-Converting Enzyme and Gallium Scan in Noninvasive Evaluation of Sarcoidosis

Abstract

Angiotensin-converting enzyme assays and gallium-scan results were obtained from 27 patients with biopsy-proven, clinically active sarcoidosis. Twenty-three of these patients had elevated converting enzyme levels, and 22 had positive gallium-scan results. Three of four patients with normal or borderline-elevated levels of angiotensin-converting enzyme also had positive gallium-scan results. Of 156 nonsarcoid patients (pulmonary and other diseases), 27 were found to have elevated serum converting enzyme levels, and 25 of these had negative gallium-scan results. These results indicate that the combination of an assay of angiotensin-converting enzyme and gallium scan increases diagnostic specificity from 83% to 99% without sacrificing sensitivity. We conclude that the concurrent use of angiotensin-converting enzyme assay and gallium scan is of value in the diagnosis of sarcoidosis.

Focal Segmental Glomerulosclerosis Associated with Pulmonary Sarcoidosis

“…Minimalchange nephropathy and focal segmental glomerulosclerosis are thought to be related to T-lymphocyte dysfunction [13], Disturban ces in the production o f some cytokines could lead to an increase in glomerular permeability [14], Local excess of interleukin-2 or related substances or oversecretion of interleukin-1 could alter glomerular permeability [13][14][15], Further support for a lymphokine-mediated pathogenesis of nephrotic syndrome is indirectly provided by the response of both conditions to corticosteroids, which are known to exert an effect upon T-cell-mediated lymphopoiesis as well as being able to block the production of lymphokines. The fact that prednisone therapy of this patient was accompanied by a rapid clinical response of the systemic manifestations associated with suppression of angiotensin-converting enzyme synthesis in the lung [16], and con comitantly, with remission of nephrotic syn drome is consistent with the concept that cor ticosteroids are capable of suppressing a fac tor produced by activated T lymphocytes. In summary, immunological abnor malities in some patients with sarcoidosis may lead to nephrotic syndrome.…”

Hyaluronate in bronchoalveolar lavage fluid: a new marker in sarcoidosis reflecting pulmonary disease.

“…Serum angiotensin converting enzyme activity was measured by spectrophotometry according to the principles outlined by Liebermann et al 2 To minimise the contribution of unspecific absorbance each sample of extracted hippuric acid was filtered through a Duropore filter (0 25 jim) (Millipore). The normal range (8-32 kU/l) was based on measurements in 104 healthy controls aged fig 1) had had known disease for less than six months.…”

Absolute quantitation of gallium-67 citrate accumulation in the lungs and its importance for the evaluation of disease activity in pulmonary sarcoidosis

“…the region with which 67Ga lung uptake is compared (Bisson et al 1983;Duffy et al 1986;Line et al 1978;Nosal et al 1979;Wesselius et al 1983). In fact, physiological hepatic accumulation of 67Ga varies from one patient to another in accordance with the serum levels of transferrin and lactoferrin, and hepatic disease may also play a role in causing such variation (Bourguet et al 1986).…”

“…Therefore, it is important that it be determined as precisely as possible (Bourguet et al 1986). Most studies have evaluated this Correspondence to: M. Myslive~ek problem qualitatively (Alberts et al 1981;Nosal et al 1979) or semiquantitatively (Rohatgi and Baier 1983;Duffy et al 1986;Line et al 1978). The fact that these subjective methods of evaluation of gallium scintigrams do not have a high degree of accuracy is especially obvious when the accumulation of gallium in the lung parenchyma is low (Bourguet et al 1985(Bourguet et al , 1986.…”