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Bonella F, Dm Vorselaars A, Wilde B. Kidney manifestations of sarcoidosis. J Autoimmun 2024:103207. [PMID: 38521611 DOI: 10.1016/j.jaut.2024.103207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/11/2024] [Accepted: 03/18/2024] [Indexed: 03/25/2024]
Abstract
Renal involvement is a clinically relevant organ manifestation of sarcoidosis, leading to increased morbidity and complications. Although the exact incidence remains unknown, renal disease is likely to occur in up to one third of all sarcoidosis patients. Every patient with newly diagnosed sarcoidosis should receive a renal work-up and screening for disrupted calcium metabolism. Amid various forms of glomerulonephritis, granulomatous interstitial nephritis is the most common one, but it rarely leads to renal impairment. Histologically, granulomas can be absent. Nephrocalcinosis and nephrolithiasis are frequent forms when hypercalcaemia or hypercalciuria occur. Drugs used for treatment of systemic sarcoidosis can also cause renal damage. Due to its high heterogeneity, renal sarcoidosis can be difficult to treat. Glucocorticoids and various immunosuppressive treatments have been proven to be effective based on case series, but clinical trials are lacking. A treatment guideline for renal sarcoidosis is urgently needed. In this review article, we present an overview of the different forms of renal sarcoidosis and the diagnostic steps to confirm renal involvement; in addition, we provide insights on the management and available treatments. A better understanding regarding the pathogenesis of sarcoidosis is the key for the development of more specific, targeted therapies.
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Affiliation(s)
- Francesco Bonella
- Center for interstitial and rare lung diseases, Ruhrlandklinik University Hospital, University of Duisburg-Essen, Essen, Germany.
| | - Adriane Dm Vorselaars
- Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands; Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Benjamin Wilde
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Ahmed R, Najam N, Ramphul K, Mactaggart S, Dulay MS, Okafor J, Azzu A, Bilal M, Memon RA, Sakthivel H, Khattar R, Wells AU, Baksi JA, Wechalekar K, Kouranos V, Chahal A, Sharma R. Characteristics and clinical outcomes of patients with sarcoidosis admitted for ST-elevation myocardial infarction in the United States: a propensity matched analysis from the National Inpatient Sample. Arch Med Sci Atheroscler Dis 2024; 9:e47-e55. [PMID: 38846054 PMCID: PMC11155460 DOI: 10.5114/amsad/184701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 02/20/2024] [Indexed: 06/09/2024] Open
Abstract
Introduction Sarcoidosis is a systemic inflammatory disorder characterised by non-caseating granulomas. Cardiac sarcoidosis (CS) normally causes conduction abnormalities, ventricular arrhythmias, and heart failure. Little is known about the characteristics and impact of sarcoidosis in patients admitted with ST-elevation myocardial infarction (STEMI). This study aims to fill this void. Material and methods Utilising the National Inpatient Sample (NIS) database (2016-2020), individuals with STEMI were identified and categorised based on sarcoidosis presence whilst adjusting for confounders via logistic regression models. Results Among 851,290 STEMI patients, 1215 had sarcoidosis. Before propensity matching, sarcoidosis patients were notably different in demographics and comorbidities compared to non-sarcoidosis patients. After propensity score matching (PSM), sarcoidosis patients were found to have a higher incidence of supraventricular tachycardia (SVT) (2.5% vs. 1.3%, p = 0.024) and acute kidney injury (AKI) (23.3% vs. 20.8%, aOR = 1.269, 95% CI: 1.02-1.58, p = 0.033) but a lower incidence of undergoing coronary artery bypass graft (CABG) (5.5% vs. 8.5%, aOR = 0.663; 95% CI: 0.472-0.931, p = 0.018), while no significant disparities were noted in PCI, cardiogenic shock, mortality, or mean length of stay (LOS). Conclusions Using propensity-matched large real-world data of STEMI patients, sarcoidosis was associated with fewer cases of CABG and a greater incidence of AKI and SVT compared to non-sarcoidosis patients.
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Affiliation(s)
- Raheel Ahmed
- Cardiac Sarcoidosis Services, Royal Brompton Hospital, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, United Kingdom
| | - Noem Najam
- Dow University of Health Sciences, Karachi, Pakistan
| | | | - Sebastian Mactaggart
- Northumbria Hospitals, NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | | | - Joseph Okafor
- Cardiac Sarcoidosis Services, Royal Brompton Hospital, London, United Kingdom
| | - Alessia Azzu
- Cardiac Sarcoidosis Services, Royal Brompton Hospital, London, United Kingdom
| | - Maham Bilal
- Dow University of Health Sciences, Karachi, Pakistan
| | - Rahat A Memon
- Abington Hosp-Jefferson Health, Horsham, United States
| | - Hemamalini Sakthivel
- One Brooklyn Health System/Interfaith Medical Ctr Program, Brooklyn, New York, United States
| | - Rajdeep Khattar
- Cardiac Sarcoidosis Services, Royal Brompton Hospital, London, United Kingdom
| | - Athol Umfrey Wells
- Cardiac Sarcoidosis Services, Royal Brompton Hospital, London, United Kingdom
| | - John Arun Baksi
- Cardiac Sarcoidosis Services, Royal Brompton Hospital, London, United Kingdom
| | - Kshama Wechalekar
- Cardiac Sarcoidosis Services, Royal Brompton Hospital, London, United Kingdom
| | - Vasilis Kouranos
- Cardiac Sarcoidosis Services, Royal Brompton Hospital, London, United Kingdom
| | - Anwar Chahal
- Department of Cardiology, Barts Heart Centre, London, United Kingdom
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Center for Inherited Cardiovascular Diseases, Department of Cardiology, Wellspan Health, York, USA
| | - Rakesh Sharma
- Cardiac Sarcoidosis Services, Royal Brompton Hospital, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, United Kingdom
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Ashraf H, Uczkowski D, Stuart M. Lysozyme-induced nephropathy due to systemic granulomatous disease. Clin Case Rep 2023; 11:e8122. [PMID: 38028084 PMCID: PMC10658583 DOI: 10.1002/ccr3.8122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 12/01/2023] Open
Abstract
Lysozyme-induced nephropathy is a rare form of acute tubular injury that has almost exclusively been reported in patients with monocytic malignancies. Typically, patients will present in acute renal failure A renal biopsy is necessary to confirm the diagnosis and will demonstrate proximal tubular cells with hypereosinophilic granules, which are periodic acid-Schiff and Jones methenamine silver-positive. Immunohistochemical staining for lysozyme will also be present. The following rare case will describe a case of lysozyme nephropathy in a patient without any underlying hematological malignancy, but instead with systemic granulomatous disease.
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Affiliation(s)
- Hamza Ashraf
- Overlook Medical CenterAtlantic Health SystemSummitNew JerseyUSA
| | | | - Matthew Stuart
- Overlook Medical CenterAtlantic Health SystemSummitNew JerseyUSA
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4
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Calatroni M, Moroni G, Ponticelli C. Renal replacement therapy in sarcoidosis. Front Med (Lausanne) 2023; 9:990252. [PMID: 36698835 PMCID: PMC9870065 DOI: 10.3389/fmed.2022.990252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023] Open
Abstract
Sarcoidosis is a systemic inflammatory disease of unknown etiology. Kidney involvement in sarcoidosis may be present in up 25-30% of cases. An early diagnosis and prompt treatment with corticosteroids can improve the prognosis but rarely renal sarcoidosis can lead to kidney failure needing renal replacement therapy (RRT). Acute kidney injury (AKI) in sarcoidosis may be caused by granulomatous interstitial nephritis (GIN) or hypercalcemia. These disorders are usually clinically silent and may lead end stage renal disease (ESKD) if not diagnosed or detected too late. In patients with ESKD, dialysis and renal transplantation can offer results comparable to those observed in patients with other causes of kidney failure. Based on a review of literature, we present an overview of RRT in patients with AKI or chronic kidney disease (CKD) caused by sarcoidosis.
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Affiliation(s)
- Marta Calatroni
- Department of Biomedical Sciences, Humanitas University, Milan, Italy,Nephrology and Dialysis Division, IRCCS Humanitas Research Hospital, Milan, Italy,*Correspondence: Marta Calatroni,
| | - Gabriella Moroni
- Department of Biomedical Sciences, Humanitas University, Milan, Italy,Nephrology and Dialysis Division, IRCCS Humanitas Research Hospital, Milan, Italy
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Abstract
Sarcoidosis is a systemic inflammatory disease of unknown etiology. The pathogenesis rests on an aberrant T cell response to unidentified antigens in individuals predisposed by genetic and environmental factors. Increased expression of polarized macrophages and disequilibrium between effector and regulator T cells contribute to the formation of noncaseating granulomas, that are frequently found in affected organs. The main kidney abnormalities in sarcoidosis are granulomatous interstitial nephritis (GIN) and hypercalcemia-related disorders. The clinical diagnosis is difficult. The outcome is variable, ranging from spontaneous remission to end-stage kidney disease (ESKD). Early diagnosis and prompt treatment with corticosteroids can improve the prognosis. Hypercalcemia may be responsible for acute kidney injury (AKI) caused by vasoconstriction of afferent arterioles. Complications of persistent hypercalcemia include nephrocalcinosis and renal stones. In patients with ESKD, dialysis and transplantation can offer results comparable to those observed in patients with other causes of kidney failure. Based on a review of the literature, we present an overview of the etiopathogenesis, the renal manifestations of sarcoidosis and their complications, management and prognosis.
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Gorsane I, Zammouri A, Hajji M, Sallemi N, Aoudia R, Barbouch S, Ben Abdallah T. [Renal involvement in sarcoidosis: Prognostic and predictive factors]. Nephrol Ther 2021; 18:52-58. [PMID: 34756825 DOI: 10.1016/j.nephro.2021.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/15/2021] [Accepted: 08/22/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Sarcoidosis is a systemic granulomatous disease that primarily affects the respiratory system and lymphatic vessels. Renal involvement is rare, poorly studied and found in less than 10% of cases. The objective of our study was to identify factors of poor renal prognosis and predictive factors of renal involvement during sarcoidosis. METHODS It's a retrospective study including patients hospitalized in our department for sarcoidosis with renal involvement over a period of 40 years. To study renal survival, we identified two groups of patients with renal manifestations of sarcoidosis by following their evolution: group A (n=26) represents those with renal remission or deterioration of renal function but without progression to end-stage renal disease and group B (n=8) those with progression to end-stage renal disease. To detect the predictive factors of end-stage renal disease in patients with sarcoidosis, we compared the clinical and paraclinical characteristics of our patients (group 1) to those of 44 patients with sarcoidosis without renal impairment followed in our department during the same period (group 2). RESULTS Renal involvement was observed in 34 patients hospitalized for sarcoidosis (43.6%). There were 28 women and 6 men with a sex ratio of 0,21. The mean age at diagnosis of sarcoidosis was 47.1 years. The median time from sarcoidosis diagnosis to renal disease was 2 months (range 1-72). Tubulointerstitial nephropathy was the most frequent renal manifestation observed in 24 patients (70.6%). Hypercalcemia and hypercalciuria were found in 52.9% and 46.4% respectively. Renal failure was noted in 25 patients (73.5%). Corticosteroid therapy was initiated in 33 patients (97%) associated with immunosuppressive therapy in 3 cases. Predictive factors of end-stage renal disease were advanced age at diagnosis of nephropathy (P=0.007), comorbidities (P=0.002), multi-organ involvement (P=0.041), initial renal failure (P=0.013), interstitial fibrosis (P=0.006) and renal granulomas (P=0.007). Predictive factors of renal impairment during sarcoidosis were multi-organ involvement, inflammatory syndrome and hypercalcemia. CONCLUSION Renal envolvement, although rare during sarcoidosis, can influence the prognosis hence the great interest of its early detection to prevent progression to end-stage renal failure.
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Affiliation(s)
- Imen Gorsane
- Service de néphrologie, dialyse et transplantation rénale, hôpital Charles-Nicolle, BAB Souika, 1006, Tunis, Tunisie; Faculté de médecine de Tunis, Tunisie.
| | - Asma Zammouri
- Service de néphrologie, hôpital régional Houmt-Souk, Djerba, Tunisie
| | - Meriem Hajji
- Service de néphrologie, dialyse et transplantation rénale, hôpital Charles-Nicolle, BAB Souika, 1006, Tunis, Tunisie; Faculté de médecine de Tunis, Tunisie
| | - Nadaa Sallemi
- Service de néphrologie, dialyse et transplantation rénale, hôpital Charles-Nicolle, BAB Souika, 1006, Tunis, Tunisie; Faculté de médecine de Tunis, Tunisie
| | - Raja Aoudia
- Service de néphrologie, dialyse et transplantation rénale, hôpital Charles-Nicolle, BAB Souika, 1006, Tunis, Tunisie; Faculté de médecine de Tunis, Tunisie
| | - Samia Barbouch
- Service de néphrologie, dialyse et transplantation rénale, hôpital Charles-Nicolle, BAB Souika, 1006, Tunis, Tunisie; Faculté de médecine de Tunis, Tunisie
| | - Taieb Ben Abdallah
- Service de néphrologie, dialyse et transplantation rénale, hôpital Charles-Nicolle, BAB Souika, 1006, Tunis, Tunisie; Faculté de médecine de Tunis, Tunisie
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Janssen U, Naderi S, Amann K. Idiopathic granulomatous interstitial nephritis and isolated renal sarcoidosis: Two diagnoses of exclusion. SAGE Open Med 2021; 9:20503121211038470. [PMID: 34408878 PMCID: PMC8366196 DOI: 10.1177/20503121211038470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 07/22/2021] [Indexed: 02/04/2023] Open
Abstract
Granulomatous interstitial nephritis is a rare finding in renal biopsy caused by drugs, infections, and inflammatory or autoimmune diseases. Idiopathic cases account for 18% of granulomatous interstitial nephritis in native kidneys. Sarcoidosis and drugs are the most common causes of granulomatous interstitial nephritis in Western countries, while in India tuberculosis prevails. Few cases of renal sarcoidosis without extrarenal involvement, that is, isolated renal sarcoidosis, have been reported. The diagnostic criteria of isolated renal sarcoidosis remain, however, unclear. Extrarenal sarcoidosis and other etiologies of granulomatous interstitial nephritis, in particular drug-related, have to be excluded. Some of these patients may develop extrarenal manifestations during follow-up. Changes in calcium and vitamin D metabolism are frequently observed in renal sarcoidosis and support its diagnosis. While non-necrotizing granulomas are a feature of sarcoidosis and drug-induced granulomatous interstitial nephritis, they also prevail in tuberculosis-associated granulomatous interstitial nephritis. Granulomatous interstitial nephritis caused by sarcoidosis and drugs usually responds to steroid therapy. A poor response to steroids may indicate an infectious etiology such as tuberculosis and should lead to a review of the initial diagnosis. This article gives an overview of the various etiologies of granulomatous interstitial nephritis, their frequency and histopathological characteristics, as well as potential biomarkers associated with renal sarcoidosis.
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Affiliation(s)
- Ulf Janssen
- Department of Nephrology and Diabetology, Kliniken Maria Hilf, Mönchengladbach, Germany
| | | | - Kerstin Amann
- Department of Nephropathology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
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8
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Dvoretsky LI, Krivushkin SA, Stolyarevich ES, Skrynnikova EA, Stepanchenko AP, Kolendo SE. A case of granulomatous tubulointerstitial nephritis in a patient with pulmonary sarcoidosis. TERAPEVT ARKH 2020; 92:81-83. [DOI: 10.26442/00403660.2020.06.000608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Indexed: 11/22/2022]
Abstract
A clinical observation is presented of a patient with pulmonary sarcoidosis, who was diagnosed with kidney damage after three years with the development of chronic renal failure and the need for replacement therapy. A histological examination of the renal biopsy revealed a granulomatous process in the interstitial tissue, which was regarded as an extrapulmonary manifestation of sarcoidosis. Pulse therapy with glucocorticoids was prescribed and an attempt was made to reduce hemodialysis sessions.
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9
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Al-Riyami HA, Al-Kiyumi MH, Al-Harthi RR, Al-Mahrezi AM. Sarcoidosis Presenting as a Penile Lesion: A Case Report. Oman Med J 2020; 35:e94. [PMID: 32095277 PMCID: PMC7026804 DOI: 10.5001/omj.2020.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 10/07/2018] [Indexed: 12/19/2022] Open
Abstract
Sarcoidosis is a systemic disease of unknown etiology affecting multiple organs and is characterized by the presence of non-caseating granulomas. It is very rare for patients with this condition to present initially with a penile lesion only. We report the case of a 63-year-old man who presented initially with an isolated single penile lesion. He subsequently developed multiple skin nodules over his right arm, chest, and trunk. The diagnosis of sarcoidosis was made based on clinical, radiological, and histopathological reports. The patient responded well to steroids.
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Affiliation(s)
- Hana Ali Al-Riyami
- Directorate General of Primary Health Care, Ministry of Health, Muscat, Oman
| | - Maisa Hamed Al-Kiyumi
- Department of Family Medicine and Public Health, Sultan Qaboos University Hospital, Muscat, Oman
| | - Raya Rashid Al-Harthi
- Directorate General of Primary Health Care, Ministry of Health, North Sharqiyah Region, Oman
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10
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Impaired renal function and fever of unknown origin in a patient with pediatric granulomatous arthritis: Answers. Pediatr Nephrol 2019; 34:1045-1048. [PMID: 30456665 DOI: 10.1007/s00467-018-4148-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 11/07/2018] [Indexed: 10/27/2022]
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Abstract
PURPOSE OF REVIEW The purpose of this article is to provide understanding of renal sarcoidosis, the different types of renal sarcoidosis, disease burden of renal involvement, and treatment options. RECENT FINDINGS The frequency of renal involvement seems to be underestimated, but renal sarcoidosis represents a relevant group of organ manifestations and significantly adds to the patient's morbidity. Because histopathological analysis of renal biopsy specimens can reveal various entities, a diagnostic workup is necessary in every patient with sarcoidosis. SUMMARY If systematically screened for renal manifestations are likely to occur in up to 25-30% of all sarcoidosis patients. The most common histological form of renal sarcoidosis is the granulomatous interstitial nephritis; however, granulomas can be absent. Furthermore, one can find various forms of secondary glomerulonephritis. In cases with dysregulated calcium homeostasis, nephrocalcinosis and nephrolithiasis are commonly detectable kidney diseases. AA amyloidosis or renal masses because of granuloma formation are considered to be rare manifestations. In addition to glucocorticoids various immunosuppressive treatments such as tumor necrosis factor alpha inhibitors have proven to be effective based on case series.
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Affiliation(s)
- Raoul Bergner
- Medizinische Klinik A, Klinikum der Stadt Ludwigshafen
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Mascia G, Argiolas D, Carta E, Michittu MB, Piredda GB. Acute Kidney Injury Secondary to Hypercalcemia in a Kidney Transplant Patient With Pneumocystis jirovecii Pneumonia: A Case Report. Transplant Proc 2018; 51:220-222. [PMID: 30736974 DOI: 10.1016/j.transproceed.2018.04.077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/13/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Persistent hyperparathyroidism is one of the main causes of hypercalcemia following kidney transplantation; differential diagnosis is required. CASE PRESENTATION We report the case of a 61-year-old kidney transplant recipient who underwent transplant in September 2016. She was admitted in March 2017 presenting with a 3-week history of asthenia, hypotension, and cough. Laboratory analysis showed acute kidney injury with hypercalcemia and elevation of inflammatory markers. She was initially treated with hydration therapy. A few days after admission she developed respiratory failure: chest computed tomography showed a ground-glass pattern. A diagnosis of Pneumocystis jirovecii was made on bronchoalveolar lavage. A subsequent graft biopsy was performed that revealed intratubular calcium deposition without signs of rejection. The patient was given trimethoprim/sulfamethoxazole, with improvement in pulmonary and renal function as well as improvement in hypercalcemia. CONCLUSIONS P jirovecii infection can trigger activation of intra-alveolar macrophages that leads to extrarenal vitamin D production with subsequent hypercalcemia. This rare event should be considered in renal transplant patients with pulmonary infection accompanied by hypercalcemia. In our case, hypercalcemia also provoked acute kidney injury.
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Affiliation(s)
- G Mascia
- Renal Transplant Unit, AO Brotzu, Cagliari, Italy
| | - D Argiolas
- Renal Transplant Unit, AO Brotzu, Cagliari, Italy
| | - E Carta
- Renal Transplant Unit, AO Brotzu, Cagliari, Italy.
| | - M B Michittu
- Renal Transplant Unit, AO Brotzu, Cagliari, Italy
| | - G B Piredda
- Renal Transplant Unit, AO Brotzu, Cagliari, Italy
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Rajkumar T, Lea-Henry T, Chacko B. Acute kidney injury as the presenting manifestation of sarcoidosis: A case series and review of literature. Nephrology (Carlton) 2018; 23:597-600. [DOI: 10.1111/nep.13176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Theepika Rajkumar
- Nephrology and Transplantation Unit; John Hunter Hospital; Newcastle New South Wales Australia
| | - Tom Lea-Henry
- Nephrology and Transplantation Unit; John Hunter Hospital; Newcastle New South Wales Australia
| | - Bobby Chacko
- Nephrology and Transplantation Unit; John Hunter Hospital; Newcastle New South Wales Australia
- School of Medicine and Public Health; University of Newcastle; Newcastle New South Wales Australia
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Frieder J, Kivelevitch D, Menter A. Symptomatic hypercalcemia and scarring alopecia as presenting features of sarcoidosis. Proc (Bayl Univ Med Cent) 2018; 31:224-226. [PMID: 29706828 DOI: 10.1080/08998280.2018.1435118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/04/2017] [Accepted: 12/05/2017] [Indexed: 01/29/2023] Open
Abstract
Sarcoidosis is a multisystem granulomatous disease most frequently affecting the lungs, lymph nodes, and eyes. Skin involvement occurs in approximately 25% to 35% of cases, with the scalp uncommonly affected. Abnormal calcium metabolism is associated with sarcoidosis and other granulomatous disorders and most commonly presents as hypercalciuria (40%-60%) and, less frequently, hypercalcemia (10%-20%). Symptomatic hypercalcemia is unusual, presenting in <5% of sarcoidosis patients, and rarely results in kidney damage. We report here a case of sarcoidosis presenting with severe symptomatic hypercalcemia (>14 mg/dL, 3.5 mmol/L), scarring alopecia, and acute-on-chronic kidney failure.
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Affiliation(s)
- Jillian Frieder
- Division of Dermatology, Baylor University Medical Center, Dallas, Texas
| | - Dario Kivelevitch
- Division of Dermatology, Baylor University Medical Center, Dallas, Texas
| | - Alan Menter
- Division of Dermatology, Baylor University Medical Center, Dallas, Texas
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