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2015 ; 4
(2
): 212-217
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Acute kidney injury caused by sarcoid granulomatous interstitial nephritis
without extrarenal manifestations
#MMPMID28509105
Kikuchi H
; Mori T
; Rai T
; Uchida S
CEN Case Rep
2015[Nov]; 4
(2
): 212-217
PMID28509105
show ga
Granulomatous interstitial nephritis (GIN) is one of the renal pathological
manifestations of sarcoidosis. It is usually clinically silent, but may present
occasionally as acute kidney injury (AKI). AKI caused by sarcoid GIN without
extrarenal manifestations is extremely rare. We report a case of a 70-year-old
man with a history of type 2 diabetes mellitus admitted with progressively
worsening kidney function. The patient also exhibited anorexia, malaise and
weight loss. Laboratory tests showed an elevated serum lysozyme level, but the
serum angiotensin-converting enzyme (ACE) and serum calcium levels were normal.
Increased uptake was evident only in kidney on gallium 67 scintigraphy. Although
typical organ involvement of sarcoidosis was not evident, a renal biopsy showed
granulomatous interstitial nephritis with non-caseating granulomas. No
medications had been added in the 3 years preceding renal function deterioration.
Following a bronchoalveolar lavage that revealed a high CD4:CD8 ratio, and a skin
test that showed negative for tuberculin, a diagnosis of renal sarcoidosis was
established. On diagnosis, oral prednisolone was initiated and renal function
improved. The anorexia and malaise also disappeared. This is the extremely rare
case of AKI caused by sarcoid GIN without extrarenal manifestations or elevated
serum ACE level.