Isolated Renal Relapse of Sarcoidosis under Low-Dose Glucocorticoid Therapy

Abstract

Sarcoidosis is a multisystem disease of unknown etiology. Renal manifestation is rare and usually caused by hypercalcemia and nephrocalcinosis. Moreover, renal disease can occur as granulomatous interstitial nephritis (GIN), which is a histological diagnosis. We describe a case of sarcoidosis first presenting with multiple organ involvement including renal failure caused by severe GIN and subsequent remission on glucocorticoid therapy. After 18 months under low-dose prednisolone, the patient was readmitted with acute renal failure, histologically confirmed to be a relapse of renal sarcoidosis. Extrarenal manifestations of sarcoidosis were not present. Glucocorticoid dose was raised and kidney function again recovered significantly. Usual serologic markers of disease activity were not appropriate to indicate disease activity. Renal manifestation of sarcoidosis should be diagnosed by renal biopsy to guide therapy and probably requires larger glucocorticoid doses and prolonged treatment to prevent relapse.

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.…”