Sarcoidosis Within a Renal Allograft: A Case Report and Review of the Literature

Mann, D. M.; Fyfe, Billie; Osband, Adena J.; Lebowitz, Jonathan; Laskow, David A.; Jones, Jerry W.; Mann, Richard A.

doi:10.1016/j.transproceed.2012.11.008

Cited by 16 publications

(7 citation statements)

References 24 publications

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“…When present, vasculitis of the renal artery is commonly associated with hypertension [32]. The recurrence in transplant recipients renal of renal sarcoidosis is not rare [33]. In one report, sarcoidosis recurred in five patients (27%), including two who had extra renal involvement and three who had renal involvement [34].…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Acute Renal Failure in Sarcoidosis: A Review of the Literature

Papalia¹

2016

Arch Clin Nephrol

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We report two cases of acute kidney failure (ARF) as the initial manifestation of sarcoidosis. Two patients were sent from their primary care physicians with hypercalcemia and progressive increase of serum creatinine. The renal biopsy revealed granulomatous interstitial nephritis (GIN). Both patients were started on Methylprednisolone pulse therapy, followed by administration of oral prednisolone and by a slow taper thereafter to a maintenance dose. The renal function has improved immediately in response to this therapy. Our cases demostrates thet GIN due to sarcoidosis, although a rare entity, can cause severe ARF and progressive ESRD. With early detection and appropriate therapy, the majority of patients will maintain adequate renal function. Therefore the diagnosis of renal sarcoidosis must be done quickly to prevent renal. uptake on Computed tomography (CT) scan of this chest, elevated serum ACE level, hypercalcemia (12.3 mg/dL), splenomegaly, retinal degeneration, nonischemic cardiomyophathy with hypertrophy on echocardiography, no pathognomonic skin lesions. Serologic testing showed normal complement levels and negative results for anti-nuclear antibody, double-stranded DNA, antineutrophil cytoplasmic antibody (ANCA). The presence of hypercalcemia and very low PTHi might be mistaken for Multiple Myeloma. Monoclonal Gammopathies were excluded by normal serum immunofixation, absent Bence Jones proteinuria and absent κ and λ free light chains (FLC). A skeletal survey showed no lytic or blastic osseous lesions. Active tubercolosis, fungal infection, viral hepatitis, vasculitis and malignancy were clinically excluded. The patient started with Methylprednisolone pulse therapy, followed by administration of oral prednisolone (1.0 mg/Kg/die) for 12 weeks and by a slow taper thereafter to a maintenance dose of 10 mg for an additional six months period. The renal function and hypercalcemia improved immediately in response to this therapy after one month. The follow up was marked by complete resolution of clinical and biological signs. Case No 2 We report the case of a 53-year-old Caucasian woman presenting acute renal failure (ARF), proteinuria of 1.0 gr/24H, hypercalcemia and elevated 1.25 dihydroxycholecalcipherol. She had reported the onset of fatigue, weight loss (about 12 Kg), artralgia, loss of appetite a few months before hospital admission. The serum creatinine level has been documented to be 1.0 mg/dL two months before hospitalization. Her medical history included "rheumatica peliosis" when she was 22 years old, right pleurisy and erythematous maculopapular rash on her face when she was 24 years old, onset of Diabetes when she was 46 years old. On admission on physical exam, the patient was febrile, normotensive and preserved diuresis (1800 mL/24H). Upon admission, laboratory results showed creatinine of 4.7 mg/ Case No 1 A 57-year-old Caucasian man is hospitalized in our Nephrology Department with progressive increase in serum creatinine (2.48 mg/ dl; MDRD 32.6 ml/min) and proteinuria less than 500 mg/24h. ...

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Section: Clinical Manifestationsmentioning

confidence: 99%

Acute Renal Failure in Sarcoidosis: A Review of the Literature

Papalia¹

2016

Arch Clin Nephrol

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“…Ten cases of sarcoidosis involving a renal allograft have been reported; in seven of these cases, the primary renal disease was sarcoidosis [1,[4][5][6]8]. One case of calcium oxalate stones and recurrent urinary tract infections was reported, and the histological analysis of native kidney tissue revealed granulomas [3]; and the etiology of the primary renal disease was unknown in two cases [2,7]. Although the recurrence rate of sarcoidosis in renal allografts is unclear, it was reported that among the 10 recipients of kidney transplants whose primary renal disease was sarcoidosis, and who were followed for a median period of 52 (range 18-196) months, recurrence of sarcoidosis in their renal allograft was diagnosed in three [4].…”

Section: Discussionmentioning

confidence: 99%

“…All of the 10 renal allograft recipients who developed recurrent sarcoidosis in their allograft were treated with CS at various dosages and over varying treatment periods. Renal function improved in six patients [1,2,4,[6][7][8], renal function first improved but thereafter decreased with loss of the renal graft in one patient [3], renal function was not improved in one patient [4], one patient died of pulmonary embolism [4], and one patient receiving infliximab died of disseminated histoplasmosis [5]. For our patient, treatment with CS at an initial dose of 0.5 mg/kg/day did not lead to improvement in renal function but halted further deterioration, and his proteinuria improved.…”

Section: Discussionmentioning

confidence: 99%

“…Sarcoidosis is a non-caseating granulomatous disease of unknown etiology involving multiple organs. Patients whose primary renal disease was sarcoidosis or unknown have been reported as developing sarcoidosis in their renal allograft [1][2][3][4][5][6][7][8]. To the best of our knowledge, there have not been any reports of sarcoidosis that has developed in the renal allograft of a recipient whose primary renal disease was not sarcoidosis.…”

Section: Introductionmentioning

confidence: 99%

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Sarcoidosis in the renal allograft of a recipient whose primary disease was autosomal dominant polycystic kidney disease

et al. 2018

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We report a 55-year-old man with a renal allograft that developed sarcoidosis. His autosomal dominant polycystic kidney disease (ADPKD) progressed to end-stage stage renal disease when he was 52 years old, and he underwent living-donor kidney transplantation at the age of 53 years. His proteinuria worsened at 19 months post-transplantation, and his renal function began to decline at 29 months post-transplantation. A renal allograft biopsy performed at 31 months post-transplantation revealed non-caseating granulomatous interstitial nephritis. The patient was treated with prednisolone (0.5 mg/kg/day), with gradual reduction in the dose. His proteinuria improved and renal function did not deteriorate any further. To the best of our knowledge, this is the first case of sarcoidosis in a renal allograft recipient whose primary renal disease was ADPKD.

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“…Nevertheless, reactivation of known sarcoidosis has been described in the setting of KTx. 30 In the previously mentioned retrospective report on kidney histopathology, 26 a total of 2,331 kidney biopsies from renal grafts were assessed, among which two were obtained from grafts of patients who underwent KTx because of biopsy-proven renal sarcoidosis. One of these patients was found to have recurrence of granulomas on posttransplant kidney biopsy (without infections or nephrotoxic drugs), although without any signs of renal graft failure.…”

Section: Renal Disease and Kidney Transplantation In Sarcoidosismentioning

confidence: 99%

Solid Organ Transplantation in Sarcoidosis

Yserbyt

Wuyts

Verleden

et al. 2017

Semin Respir Crit Care Med

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Sarcoidosis is a chronic systemic inflammatory disease which is histopathologically characterized by the presence of noncaseating granulomas. When the extent of the disease is limited, without endangering the function of affected organs, clinical observation can be sufficient given that in a majority of cases, inflammation will subside with time. In more advanced sarcoidosis, especially when one or more specific organs are threatened, immunomodulatory treatment, of which steroids are the key element, over a prolonged period of time, in general, may attenuate disease activity. Treatment-refractory sarcoidosis (due to the lack of efficacy, drug toxicity or intolerability) may be progressive and, although infrequent, can result in end-stage organ failure. In these selected cases, solid organ transplantation (SOT) should be considered. In this article, SOT is positioned within the organ-specific treatment of systemic sarcoidosis and data on outcome after transplantation are discussed.

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Sarcoidosis Within a Renal Allograft: A Case Report and Review of the Literature

Cited by 16 publications

References 24 publications

Acute Renal Failure in Sarcoidosis: A Review of the Literature

Acute Renal Failure in Sarcoidosis: A Review of the Literature

Sarcoidosis in the renal allograft of a recipient whose primary disease was autosomal dominant polycystic kidney disease

Solid Organ Transplantation in Sarcoidosis

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