A rare case of sarcoidosis causing granulomatous interstitial nephritis presenting as non oliguric acute renal failure in the Indian subcontinent

Sapre, Chinmaye; Kolla, Praveen Kumar; Rao, Kiran V.; Sadineni, Raghavendra; Reddy, B.V. Ramana; Sharma, Sreedhar; Viswanath, Vishad; Shaik, Mahaboob Vali

doi:10.4103/1319-2442.284036

Cited by 2 publications

(1 citation statement)

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“…A negative history of drug usage and workup excluding infection, vasculitis, and autoimmune causes established the clinical-pathological diagnosis of renal sarcoidosis. Most other case reports on renal sarcoidosis present with a more insidious onset, less debilitating clinical progression, and did not require immediate renal replacement therapy [ 15 , 18 , 19 ]; in significant contrast, the clinical course of this young male featured acute kidney failure that required hemodialysis, and it was the first manifestation that prompted the work up and led to the diagnosis of sarcoidosis. Furthermore, sarcoidosis is known as a systemic granulomatous disease involving the lungs in 90% of cases [ 20 ].…”

Section: Discussionmentioning

confidence: 95%

A Rare Presentation of Sarcoidosis in a Young Male With Acute Renal Failure: A Case Report and Literature Review

De la Hoz,

Osman,

Ryad

et al. 2023

Cureus

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Sarcoidosis presents in a variety of ways, but historically, renal involvement has been considered rare with an incidence of 0.7% and is seldom the presenting feature of the illness. Concomitant involvement of kidney and bone marrow is extremely rare. Atypical forms of presentation, such as in this case, may pose a true diagnostic challenge. A 20-year-old African-American male presented to the emergency department with vague symptoms including fatigue, malaise, anorexia, right-sided lower back pain, and nausea. Acute kidney injury was clearly evident, creatinine was 19.78 mg/dL (normal range 0.60-1.20 mg/dL), and BUN was 124.0 mg/dL (normal range 5.0-25.0 mg/dL). Laboratory results were also remarkable for leukopenia, microcytic anemia, hyperkalemia, anion gap metabolic acidosis, and non-PTH dependent hypercalcemia. Interestingly, urinalysis was equivocal and both chest x-ray (CXR) and abdominopelvic computed tomography (CT) scan were unrevealing. The patient was admitted to the hospital and required renal replacement therapy to stabilize his clinical condition while planning for a renal biopsy that was later performed. While awaiting pathological results, pancytopenia developed, and a bone marrow biopsy was then obtained. On further investigation, angiotensin-converting enzyme (ACE) turned out to be significantly elevated suggesting sarcoidosis. Renal biopsy showed moderate acute tubular injury, tubulitis, extensive interstitial edema, and infiltration by numerous non-caseating granulomas, which confirmed the diagnosis of sarcoidosis. Bone marrow histopathology revealed hypocellularity but no granulomatous infiltration. The patient remained largely asymptomatic throughout his hospital stay, with no signs or symptoms suggesting the involvement of other organs. High-dose corticosteroids were started and continued outpatient after discharge while still on hemodialysis. Pancytopenia resolved while on glucocorticoids and improvement in renal function was such that after roughly two months of steroids, renal replacement therapy was no longer necessary. Overall, kidney injury severe enough to require hemodialysis associated with pancytopenia in a previously healthy 20-year-old constitutes a rather rare sarcoidosis presentation. This highlights the importance of considering sarcoidosis as a possible cause of kidney and bone marrow dysfunction and emphasizes the need for timely biopsy to facilitate accurate diagnosis and early initiation of appropriate therapy to avoid delayed or inadequate care, especially considering that even severe damage is potentially reversible when identified early and treated promptly.

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Section: Discussionmentioning

confidence: 95%