Renal Failure Found during the Follow-up of Sarcoidosis: The Relevance of a Delay in the Diagnosis of Concurrent Hypercalcemia

Hishida, Erika; Masuda, Tomoyuki; Akimoto, Tetsu; Sato, Ryuta; Wakabayashi, Natsuko; Miki, Atsushi; Otani, Naoko; Imai, Toshimi; Sugase, Taro; Takeda, Shin‐ichi; Muto, Shigeaki; Nagata, Daisuke

doi:10.2169/internalmedicine.55.6194

Cited by 4 publications

(3 citation statements)

References 23 publications

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“…However, it is difficult to prove the causality between vaccination and AIN because tubulointerstitial nephritis has a wide range of etiologies, including medication (e.g. non-steroidal antiinflammatory drugs, proton pump inhibitors, and antibiotics), autoimmune diseases (such as Sjögren's syndrome, IgG4-related disease, sarcoidosis, and rarely ANCAassociated vasculitis), infection, and tubulointerstitial nephritis and uveitis syndrome (28)(29)(30). In our case, we considered there to be a strong relationship between the SARS-CoV-2 mRNA vaccination and AIN for the following reasons: a persistent fever and AKI within a short duration following vaccination, no other additional medicines prescribed before hospitalization, and few clinical signs suggestive of infection or autoimmune disease at the initial visit.…”

Section: Discussionmentioning

confidence: 99%

Acute Interstitial Nephritis with Glomerular Capillary IgA Deposition Following SARS-CoV-2 mRNA Vaccination

Hishida,

Ono,

et al. 2023

Intern. Med.

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We herein report a case of acute kidney injury (AKI) presenting as acute interstitial nephritis (AIN) after the first dose of the BNT162b2 mRNA vaccine against coronavirus disease 2019 (COVID-19). A 69-year-old man with a history of diabetes and hypertension presented with AKI 4 days after receiving the vaccine. Despite the administration of methylprednisolone pulse treatment, his renal function worsened, which prompted us to initiate temporal hemodialysis. His renal function subsequently improved, and a renal biopsy confirmed AIN and glomerular capillary IgA deposition without apparent crescents. The clinical history and histological findings suggest a relationship between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination and AIN as a rare side effect.

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Section: Discussionmentioning

confidence: 99%

Acute Interstitial Nephritis with Glomerular Capillary IgA Deposition Following SARS-CoV-2 mRNA Vaccination

Hishida,

Ono,

et al. 2023

Intern. Med.

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“…An increase in the production of 1,25-(OH) 2 D 3 by noncaseating granulomas has been implicated in calcium metabolism disorder. An elevated level of 1,25-(OH) 2 D 3 enhances intestinal calcium absorption and promotes osteoclastic activity and bone resorption, resulting in hypercalcemia and hypercalciuria [8][9][10].…”

Section: Discussionmentioning

confidence: 99%

Relevance of concurrent hypercalcemia in ureteric sarcoidosis complicated with bladder urothelial carcinoma: a case report

et al. 2020

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Background: Sarcoidosis is a multisystem inflammatory disorder and can affect any organ; however, ureteric involvement is extremely rare with only four cases reported in the literature to date, all of which were diagnosed with surgical ureteral resection including a nephroureterectomy. This study reports the first case of ureteric sarcoidosis controlled with medical therapy where a differential diagnosis was performed based on the diagnostic clue of hypercalcemia. A definitive diagnosis was established without surgical resection of the ureter. Case presentation: A 60-year-old man presented with anorexia and weight loss. Blood tests showed renal dysfunction and hypercalcemia. Computed tomography revealed left hydronephrosis associated with left lower ureteral wall thickening, which showed high signal intensity on diffusion-weighted magnetic resonance imaging. Similarly, we detected a bladder tumor on cystoscopy, and a 2-cm-long stenosis was revealed by retrograde ureterography; therefore, ureteral cancer was suspected. Meanwhile, considering the clinical implication of hypercalcemia, a differential diagnosis of sarcoidosis was established based on elevated levels of sarcoidosis markers. Fluorodeoxyglucose positron emission tomography showed fluorodeoxyglucose accumulation in the left lower ureter, skin, and muscles, suggestive of ureteric sarcoidosis with systemic sarcoid nodules. For a definitive diagnosis, transurethral resection of the bladder tumor and ureteroscopic biopsy were performed. Histopathological examination revealed ureteric sarcoidosis with bladder urothelial carcinoma. Following an oral administration of prednisolone, hypercalcemia instantly resolved, the renal function immediately improved, and the left ureteral lesion showed complete resolution with no recurrence. Conclusions: In this case, the co-occurrence of ureteral lesion with bladder tumor evoked a diagnosis of ureteral cancer. However, considering a case of ureteral lesion complicated with hypercalcemia, assessment for differential diagnosis was performed based on the calcium metabolism and sarcoidosis markers. In cases of suspected ureteric sarcoidosis from the assessment, pathological evaluation with ureteroscopic biopsy should be performed to avoid nephroureterectomy.

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“…Renal failure prevelance range from 0.7% to 4.3% of cases in previous reported clinical series of patients with sarcoidosis but renal failure from granulomatous interstitial nephritis induced nephropathy itself is rare. [6][7][8] A previous study found that 46 of 9,779 (0.5%) renal biopsy specimens had granulomatous interstitial nephritis. The pathology contributing to acute kidney injury from GIN in sarcoidosis is thought to be due to noncaseating granulomatous inflammation, which is composed of a central follicle of macrophages, epithelioid cells, and multinucleated giant cells.…”

Section: Discussionmentioning

confidence: 99%

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

Nasser

Gassan

Soboh

et al. 2016

CRIM

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Background: Childhood sarcoidosis is a multisystem granulomatous disorder of unknown etiology. The disease affects childrenaged 13-15 years, especially the lungs.Objective: We describe a 13-year-old boy who presented to our pediatric nephrology division due to acute renal failure, cutaneousrash and anemia.Methods: Percutaneous kidney biopsy was performed showing non-caseating granulomas with mononuclear infiltrates.Results: Mantoux test and serology for Brucella were negative. Chest radiograph showed minimal, bilateral infiltrates. Renalultrasound showed nephrocalcinosis. Pulmonary functions study demonstrated mild restrictive disturbance. Plasma creatininewas 1.8 mg/dl and calcium 12.3 mg/dl.Conclusion: In the current patient, renal insufficiency was discovered while exploring constitutional symptoms in a 13-year-oldchild. Early diagnosis and adapted treatment allows preserving renal function.

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Renal Failure Found during the Follow-up of Sarcoidosis: The Relevance of a Delay in the Diagnosis of Concurrent Hypercalcemia

Cited by 4 publications

References 23 publications

Acute Interstitial Nephritis with Glomerular Capillary IgA Deposition Following SARS-CoV-2 mRNA Vaccination

Acute Interstitial Nephritis with Glomerular Capillary IgA Deposition Following SARS-CoV-2 mRNA Vaccination

Relevance of concurrent hypercalcemia in ureteric sarcoidosis complicated with bladder urothelial carcinoma: a case report

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

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