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Granulomatous sarcoid nephritis

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      Abstract

      A patient with impaired renal function due to granulomatous sarcoid replacement of the renal parenchyma is described through two separate courses of therapy with corticosteroids. Serial measurements of renal function, periodic renal scintiscans and intravenous pyelograms, and serial histologic studies of the kidney by percutaneous renal biopsy are presented.
      The variety of modes by which sarcoidosis may affect the kidneys is reviewed. Hypercalcemia or hypercalciuria is responsible for most instances of renal disease from sarcoidosis. In the present case, kidney damage resulted from extensive replacement of renal parenchyma by sarcoid lesions in the absence of hypercalcemia or hypercalciuria. The value of renal biopsy is seriously limited by reason of the focal nature of the disease and the chance of sampling error. Renal scintiscan provided not only presumptive evidence for diagnosis but also a method to assess the extent of the disease and the effect of therapy. Serial determination of renal function demonstrated improvement following each course of therapy. However, a gradual decrease in creatinine clearance was observed during the prolonged second course of steroid therapy without increase in sarcoid “lesions” by scintiscan. It is considered likely that fibrosis associated with regression or healing of active granulomas may have been responsible. It is concluded that alternate periods of exacerbation followed by regression with steroid therapy should be avoided because of the potential of progressive fibrosis and destruction of renal parenchyma.
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      References

        • Longcope W.T.
        • Freiman D.G.
        Study of sarcoidosis based on combined investigation of 160 cases including 30 autopsies from Johns Hopkins Hospital and Massachusetts General Hospital.
        Medicine. 1952; 31: 1
        • Branson J.H.
        • Park J.H.
        Sarcoidosis—hepatic involvement. Presentation of case with fatal liver involvement including autopsy findings and review of evidence for sarcoid involvement of liver as found in literature.
        Ann. Int. Med. 1954; 40: 111
        • Klinefelter Jr., H.F.
        • Salley S.M.
        Sarcoidosis simulating glomerulonephritis.
        Bull. Johns Hopkins Hosp. 1946; 79: 333
        • Lofgren S.
        • Snellman B.
        • Lindgren A.G.H.
        Renal complications in sarcoidosis functional and biopsy studies.
        Acta med. scandinav. 1957; 159: 295
        • Klatskin G.
        • Gordon M.
        Renal complications of sarcoidosis and their relationship to hypercalcemia.
        Am. J. Med. 1953; 15: 484
        • Scholz D.A.
        • Keating Jr., F.R.
        Renal insufficiency, renal calculi and nephrocalcinosis in sarcoidosis. Report of eight cases.
        Am. J. Med. 1956; 21: 75
        • Berger K.W.
        • Relman A.S.
        Renal impairment due to sarcoid infiltration of the kidney.
        New England J. Med. 1955; 252: 44
        • Ogilvie R.L.
        • Kaye M.
        • Moore S.
        Granulomatous sarcoid disease of the kidney.
        Ann. Int. Med. 1964; 61: 711
        • Panitz F.
        • Shinaberger J.H.
        Nephrogenic diabetes insipidus due to sarcoidosis without hypercalcemia.
        Ann. Int. Med. 1965; 62: 115
        • Rosenthal S.R.
        Pathological and experimental studies of Boeck's sarcoid. I. Report of a case with panarteritis, periarteritis, terminal hypertension and uremia and the production of sarcoid-like lesion in guinea pigs.
        Am. Rev. Tuberc. 1949; 60: 236
        • Ricker W.
        • Clark M.
        Sarcoidosis. Clinicopathologic review of 300 cases, including 22 autopsies.
        Am. J. Clin. Path. 1949; 19: 725
        • Rutishauser E.
        • Rywlin A.
        Besnier-Boeck renal.
        J. d'Urol. 1950; 56 (Paris): 277
        • Cameron H.M.
        Renal sarcoidosis.
        J. Clin. Path. 1956; 9: 136
        • Sorger K.
        • Taylor W.A.
        Generalized sarcoidosis. Report of a case terminating in fatal nephropathy.
        Arch. Path. 1961; 71: 35
        • Roe J.H.
        • Epstein J.H.
        • Goldstein N.P.
        A photometric method for the determination of inulin in plasma and urine.
        J. Biol. Chem. 1949; 178: 839
        • Brun C.
        A rapid method for the determination of para-aminohippuric acid in kidney function tests.
        J. Lab. & Clin. Med. 1951; 37: 955
        • Kleeman C.R.
        • Maxwell M.H.
        Regulation of body water.
        in: Clinical Disorders of Fluid and Electrolyte Metabolism. McGraw-Hill Book Co, New York1962: 156
        • Smith H.W.
        Principles of Renal Physiology.
        in: Oxford University Press, New York1956: 32
        • Chapman E.M.
        • Halstead J.A.
        The fractional phenolsulfonphthalein test in Bright's disease.
        Am. J. M. Sc. 1933; 186: 223
        • Zak C.A.
        • Brun C.
        • Smith H.W.
        The mechanisms of formation of osmotically concentrated urine during the antidiuretic state.
        J. Clin. Invest. 1954; 33: 1064
        • Kuznitzky E.
        • Bittorf A.
        Boecksches Sarkoid mit Beteilung innerer Organe.
        München. med. Wchnschr. 1915; 62: 1349
        • Schaumann J.
        Lymphogranulomatosis benigna in the light of prolonged clinical observation and autopsy findings.
        Brit. J. Dermat. 1936; 48: 399
        • Chanial G.
        Étiologie du syndrome de Besnier-Boeck.
        Thése de Lyon. 1937;
        • Chanial G.
        Besnier-Boeck renal.
        J. d'Urol. 1950; 56 (Cited by E. Rutishauscr and A. Rywlin) (Paris): 277
        • Bottcher E.
        Disseminated sarcoidosis with a marked granulomatous arteritis.
        Arch. Path. 1959; 68: 419
        • Henneman P.H.
        • Carroll E.L.
        • Dempsey E.F.
        Mechanism responsible for hypercalciuria in sarcoid.
        J. Clin. Invest. 1954; 33: 941
        • Bell N.H.
        • Gill Jr., J.R.
        • Bartter F.C.
        On the abnormal calcium absorption in sarcoidosis. Evidence for increased sensitivity to vitamin D.
        Am. J. Med. 1964; 36: 500
        • Freiman D.G.
        Sarcoidosis.
        New England J. Med. 1948; 239: 664
        • Freiman D.G.
        Sarcoidosis.
        New England J. Med. 1948; 239: 709
        • Freiman D.G.
        Sarcoidosis.
        New England J. Med. 1948; 239: 743
        • Mayock R.L.
        • Bertrand P.
        • Morrison C.E.
        • Scott J.H.
        Manifestations of sarcoidosis.
        Am. J. Med. 1963; 35: 67
        • Dent C.E.
        • Flynn F.V.
        • Nabarro J.D.
        Hypercalcemia and impairment of renal function in generalized sarcoidosis.
        Brit. M. J. 1953; 2: 808
        • Teilum G.
        Glomerular lesions of kidneys in sarcoidosis (Boeck's sarcoid).
        Acta path. et microbiol. scandinav. 1951; 28: 294
        • McPhaul J.J.
        • McIntosh D.A.
        • Rhoades E.R.
        • Hammond W.C.
        • Flume J.L.
        The renal lesion of sarcoidosis.
        Clin. Res. 1964; 12: 49
        • Morris R.C.
        • Johnson L.B.
        • Fudenberg H.
        Impairment of renal acidification in hypergammaglobulinemic patients.
        Clin. Res. 1965; 13: 115
        • Teilum G.
        Morphogenesis and development of sarcoid lesions: similarities to the group of collagenoses.
        Acta med. scandinav. 1964; 176: 14
        • Jonas Jr., A.F.
        Granulomatous myocarditis.
        Bull. Johns Hopkins Hosp. 1939; 64: 45
        • Correa P.
        Sarcoidosis associated with glomerulonephritis.
        Arch. Path. 1954; 57: 523
        • Parker J.G.
        Generalized sarcoidosis with uremia due to congenital single fused polycystic kidney: necropsy findings in a case previously reported as renal sarcoidosis.
        Dis. Chest. 1950; 18: 49
        • Rotenberg L.
        • Guggenheim A.
        Boeck's sarcoid: report of a case with renal involvement.
        Dis. Chest. 1942; 8: 392
        • Epstein F.H.
        • Rivera M.J.
        • Carone F.A.
        Effect of hypercalcemia induced by calciferol upon renal concentrating ability.
        J. Clin. Invest. 1958; 37: 1702
        • Fourman P.
        • McConkey B.
        • Smith J.W.G.
        Defects of water reabsorption and of hydrogen ion excretion by the renal tubules in hyperparathyroidism.
        Lancet. 1960; 1: 619
        • Heinemann H.O.
        Reversible defect in renal ammonium excretion in patients with hypercalcemia.
        Metabolism. 1963; 12: 792
        • Ferris T.
        • Kashgarian M.
        • Leuitan H.
        • Brandt I.
        • Epstein F.H.
        Renal tubular acidosis and renal potassium wasting acquired as a result of hypercalcemic nephropathy.
        New England J. Med. 1961; 265: 924
        • Anderson G.S.
        • Graham A.G.
        Renal sarcoidosis and nephrolithiasis.
        Scottish M. J. 1960; 5: 392
        • Cantwell D.F.
        Clinical notes: sarcoidosis with renal involvement.
        Irish J. M. Sc. 1954; 6: 223
        • Horton R.
        • Lincoln N.S.
        • Pinner M.
        Noncaseating tuberculosis: case reports.
        Am. Rev. Tuberc. 1939; 39: 186
        • Snapper I.
        On Boeck's sarcoid.
        Connecticut M. J. 1948; 12: 99
        • Salveson H.A.
        The sarcoid of Boeck, a disease of importance to internal medicine.
        Acta med. scandinav. 1935; 86: 127
        • Bell N.H.
        • Bartter F.C.
        Transient reversal of hyperabsorption of calcium and of abnormal sensitivity to vitamin D in a patient with sarcoidosis during an episode of nephritis.
        Ann. Int. Med. 1964; 61: 702
        • McAfee J.G.
        • Wagner H.N.
        Visualization of renal parenchyma by scintiscanning with Hg203 neohydrin.
        Radiology. 1960; 75: 820
        • Izenstark J.L.
        • Borden J.J.
        • Mardis H.K.
        • Varella R.
        Clinical indications for kidney scanning.
        J.A.M.A. 1964; 188: 136
        • Nagle R.
        Hypercalcemia and nephrocalcinosis in sarcoidosis.
        J. Mt. Sinai Hosp. 1961; 28: 268
        • Kogut M.D.
        • Neumann L.L.
        Renal involvement in Boeck's sarcoidosis.
        Pediatrics. 1961; 28: 410
        • Citron K.M.
        Renal impairment in sarcoidosis with special reference to nephrocalcinosis.
        Postgrad. M. J. 1955; 31: 516
        • Schlitt L.E.
        • keitel H.G.
        Renal manifestations of sickle cell disease: a review.
        Am. J. M. Sc. 1960; 239: 773