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Sarcoidosis in the Kidney: Nephrology Insights

Explore the impact of sarcoidosis on renal health, from granulomatous interstitial nephritis to glomerular diseases. Learn about clinical presentations, diagnostic challenges, and treatment approaches in this Grand Rounds presentation.

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Sarcoidosis in the Kidney: Nephrology Insights

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  1. Nephrology Grand Rounds 6/17/08

  2. Sarcoidosis in the kidney Brad Weaver

  3. Sarcoidosis • Multisystem & heterogeneous disease of unknown etiology characterized by noncaseatinggranulomas • Three to four times more common among blacks • Most often presents between ages 10-40 • Common symptoms • Cough • Skin lesions • Eye lesions • Systemic: fatigue, malaise, fever, and weight loss • CXR often shows b/lhilaradenopathy and/or pulmonary reticular opacities

  4. Organ involved # % Am J Respir Crit Care Med 2001;164:1885.

  5. Lab findings in sarcoidosis • Eosinophilia 25% • Leukopenia 5-10% • Hypergammaglobulinemia 30-80% • Elevated serum ACE level 75%. False positives are rare. • BAL showing increased CD4/CD8 ratio • Hypercalcemia 2/2 extrarenal production of calcitriol by activated macrophages • Hypercalciuria is reported to be more common than hypercalcemia

  6. Renal involvement • Sarcoidosis can cause wide variety of renal disease including ESRD • Histologic changes are more common than clinical disease which is rare • 20-50% on several small series of kidney biopsies and postmortem analysis • Nephrolithiasis : may be the presenting symptom of sarcoidosis • Polyuria • Nephrogenic DI: 2/2 hypercalcemia • Central DI: 2/2 granulomas in hypothalamus (also can cause primary polydipsia)

  7. Granulomatous acute interstitial nephritis Granuloma Interstitial Inflammation

  8. Retrospective study • 40 cases of renal granulomas found on kidney biopsy • Etiologies were determined: • Sarcoidosis 20 (50%) • Drug-induced 7 (17.5%) • TB 3 (7.5%) • Wegener’s 2 (5%) • Leprosy 1 (2.5%) • Mycobacterium avium 1 (2.5%) • Crohn’s disease 1 (2.5%) • No etiology determined 5 (12.5%) Medicine (Baltimore). 2007 May;86(3):170-80.

  9. Renal involvement cont. • Glomerular disease: case reports of membranous, proliferative & crescentic GN, & FSGS • Urinary tract obstruction • Nephrolithiasis • RP fibrosis • RP lymph node enlargement • Treatment: prednisone 1mg/kg/day • Transplant has been reported to be successful

  10. TINU syndrome • Tubulointerstitial nephritis & uveitis (TINU): rare disorder thought to be related to sarcoidosis • About 140 cases have been reported in mainly adolescents & young women • Renal disease can present as flank pain, sterile pyuria, & acute renal failure & often resolve on its own • Cases of progressive renal failure have been treated w/ 3-6 mo. of prednisone

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