Granulomatous Interstitial Nephritis Presenting as Hypercalcemia and Nephrolithiasis

Abstract

We report a case of acute kidney injury as the initial manifestation of sarcoidosis. A 55-year-old male was sent from his primary care physician's office with incidental lab findings significant for hypercalcemia and acute kidney injury with past medical history significant for nephrolithiasis. Initial treatment with intravenous hydration did not improve his condition. The renal biopsy subsequently revealed granulomatous interstitial nephritis (GIN). Treatment with the appropriate dose of glucocorticoids improved both the hypercalcemia and renal function. Our case demonstrates that renal limited GIN due to sarcoidosis, although a rare entity, can cause severe acute kidney injury and progressive renal failure unless promptly diagnosed and treated.

Activated Macrophage and Granulomatous Inflammation

“…Renal failure or renal disorder is may also cause by granulomatous interstitial nephritis (GIN) [16], a rare condition. Sarcoidosis, granulomatous with polyangiitis, and infectious agents are the most common causes (particularly renal tuberculosis).…”

Idiopathic granulomatous interstitial nephritis and isolated renal sarcoidosis: Two diagnoses of exclusion

“…4 Furthermore, sarcoidosis may relapse isolated in the kidney after treatment of initial presentation with multiple organ involvement. 24 However, careful review of reported cases of isolated renal sarcoidosis reveals a history of drug intake associated with GIN, such as non-steroidal anti-inflammatory drug (NSAID), 25 or extrarenal disease manifestations, such as mediastinal and hilar lymphadenopathy 26 or joint involvement, 27 in some. In these cases, the diagnosis of isolated renal sarcoidosis may be doubted.…”

Renal insufficiency as a primary manifestation of sarcoidosis in a 13-year-old boy

“…Disturbance in calcium balance occurs due to extrarenal excess production of 1,25-dihydroxyvitamin D by sarcoid macrophages and, subsequently, increased intestinal absorption of calcium. [12][13][14] Biopsy will reveal infiltration of mononuclear cells to the interstitium leading to formation of non-caseating granulomas and chronic interstitial fibrosis. [4,5,15] Although uncommon, renal involvement in childhood sarcoidosis is usually diagnosed relatively late and 40% of affected children will continue with insufficiency after treat-ment.…”