Sarcoidosis as a cause of unappreciated hypercalcaemia in a patient with end-stage renal disease on peritoneal dialysis

Kwon, Ah Reum; Koh, Eun Sil; Chung, Sungjin; Kim, Yong Kyun

doi:10.1136/bcr-2013-010017

Cited by 3 publications

(1 citation statement)

References 10 publications

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“…However, a small number of patients with long-term asymptomatic hypercalcemia and hypercalciuria may still develop nephrocalcinosis and require RRT (57)(58)(59). In many instances, patients needing regular dialysis for unknown causes develop asymptomatic or oligosymptomatic hypercalcemia which reveal the presence of an underlying sarcoidosis (60,61). Both periodic hemodialysis and continuous ambulatory peritoneal dialysis have been successfully used in patients with uremic sarcoidosis.…”

Section: Regular Dialysismentioning

confidence: 99%

Renal replacement therapy in sarcoidosis

Calatroni

Moroni

Ponticelli³

2023

Front. Med.

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Sarcoidosis is a systemic inflammatory disease of unknown etiology. Kidney involvement in sarcoidosis may be present in up 25–30% of cases. An early diagnosis and prompt treatment with corticosteroids can improve the prognosis but rarely renal sarcoidosis can lead to kidney failure needing renal replacement therapy (RRT). Acute kidney injury (AKI) in sarcoidosis may be caused by granulomatous interstitial nephritis (GIN) or hypercalcemia. These disorders are usually clinically silent and may lead end stage renal disease (ESKD) if not diagnosed or detected too late. In patients with ESKD, dialysis and renal transplantation can offer results comparable to those observed in patients with other causes of kidney failure. Based on a review of literature, we present an overview of RRT in patients with AKI or chronic kidney disease (CKD) caused by sarcoidosis.

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Section: Regular Dialysismentioning

confidence: 99%

Renal replacement therapy in sarcoidosis

Calatroni

Moroni

Ponticelli³

2023

Front. Med.

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Bone histomorphometry in a long-term hemodialysis patient with hypoparathyroidism and sarcoidosis

et al. 2014

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A bone biopsy specimen in a long-term hemodialysis patient with sarcoidosis coexisting with severe hypoparathyroidism has demonstrated that a persistent near physiological level of 1,25-dihydroxyvitamin D3 contributes to the preservation of bone remodeling and has the potential to retard the development of vascular calcification and atherosclerosis. Sarcoidosis-related hypercalcemia and hypoparathyroidism, which is characterized by 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) overproduction, is rarely seen in hemodialysis patients. Herein, we describe a 60-year-old Japanese woman on hemodialysis for 35 years who presented with malaise and hypercalcemia. Severe hypoparathyroidism without parathyroidectomy and a preserved 1,25(OH)2D3 level were detected. Computed tomography showed bilateral axillary lymphadenopathy and minimal aortic and soft tissue calcification. The axillary node biopsy led to a definite diagnosis of sarcoidosis. A bone biopsy specimen obtained from the right iliac crest showed remodeling of normal lamellar bone with scalloped cement lines and clear double labeling by tetracycline on fluorescence microscopy. Histomorphometric analysis revealed that the bone formation rate was preserved (30.0 %/year), together with a decrease of osteoid volume (5.75 %) and fibrous volume (0 %), indicating that the patient did not have adynamic bone disease and only showed mild disease. This is the first documented case of sarcoidosis-related hypercalcemia associated with severe hypoparathyroidism in a long-term hemodialysis patient who underwent bone histomorphometry. Our findings suggest that, in hemodialysis patients with sarcoidosis coexisting with severe hypoparathyroidism, a persistent near physiological level of 1,25(OH)2D3 contributes to the preservation of bone remodeling and has the potential to retard the development of vascular calcification and atherosclerosis.

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