Sarcoidosis with Membranous Nephropathy and Granulomatous Interstitial Nephritis.

Toda, Takayuki; Kimoto, Shigeaki; Nishio, Yasuhide; Ehara, Takasi; Sasaki, Sei

doi:10.2169/internalmedicine.38.882

Cited by 21 publications

(9 citation statements)

References 8 publications

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“…This occurred in one patient with TINU and one patient with sarcoidosis in our series. There have been case reports of membranous nephropathy in association with sarcoidosis usually with extrarenal manifestations, hypercalcemia, or elevated ACE (10,11). Our patient with membranous nephropathy had a normal CXR and normal ACE and calcium concentrations and therefore was considered to have idiopathic GIN.…”

Section: Discussionmentioning

confidence: 68%

Granulomatous Interstitial Nephritis

Joss

Morris

Young

et al. 2007

Clinical Journal of the American Society of Nephrology

162

142

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Granulomatous interstitial nephritis (GIN) is a rare histologic diagnosis. This series reports the presenting features, associated conditions, treatment, and outcome of patients with a diagnosis of GIN in Glasgow during a 15-yr period and compares this with the available literature. Eighteen cases were identified: Five cases were associated with sarcoidosis, two were associated with tubulointerstitial nephritis and uveitis, two were associated with medication, and nine were idiopathic. Patients presented with advanced renal failure (median estimated creatinine clearance 21 ml/min) and minimal proteinuria (urine albumin-to-creatinine ratio 9.9 mg/mmol). Sixteen patients were treated with prednisolone for a mean of 25 mo. Six patients relapsed with reduction in prednisolone dosage, and four patients required steroid-sparing agents. During the mean follow-up of 45 mo, renal function improved or stabilized in 17 patients; the rate of improvement in renal function was most marked in the first year after diagnosis with a gain in function of ؉1.9 ml/min per mo. The median estimated creatinine clearance at final visit was 56 ml/min. One patient required renal replacement therapy at diagnosis but recovered renal function with treatment. No patient required long-term renal replacement therapy. There was no correlation between the degree of fibrosis or inflammation on biopsy and renal outcome, and the features on biopsy did not help to determine the cause of GIN. GIN is a treatable cause of renal failure that highlights the value of renal biopsy in patients who present with renal failure even when there is minimal proteinuria. The rarity of GIN demonstrates the need for systematic data collection.Clin J Am Soc Nephrol 2: 222-230, 2007. doi: 10.2215/CJN.01790506 G ranulomatous interstitial nephritis (GIN) is a rare histologic diagnosis that is present in between 0.5 and 0.9% of native renal biopsies (1,2) and 0.6% of renal transplant biopsies (3). GIN has been associated with medication, infections, sarcoidosis, crystal deposits, paraproteinemia, and Wegener's granulomatosis and also is seen in an idiopathic form. Medicines implicated include anticonvulsants, antibiotics, nonsteroidal anti-inflammatory drugs, allopurinol, and diuretics. Mycobacteria and fungi are the main infective causes and seem to be the main causative factor in cases in renal transplants (3,4). Few studies have analyzed the natural history and treatment of GIN; the largest included only seven patients (5). The purpose of this study was to analyze clinical features and outcome of patients who had GIN and presented in Glasgow between 1990 and 2004 and to compare our data with the four largest published series (1,5-7). Materials and MethodsPatients with a diagnosis of GIN were identified by a search of electronic patient records of all patients who have attended Glasgow renal units and associated satellite clinics since 1990. Hemoglobin, serum creatinine, serum calcium concentrations, peripheral blood eosinophil count, and quantified proteinuria at diagno...

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Section: Discussionmentioning

confidence: 68%

Granulomatous Interstitial Nephritis

Joss

Morris

Young

et al. 2007

Clinical Journal of the American Society of Nephrology

162

142

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“…8 In this context, a variety of further different histological lesions associated with glomerular involvement in sarcoidosis including membranous nephropathy, diffuse proliferative or crescentic glomerulonephritis, and focal segmental glomerulosclerosis have been described in some cases and may emphasize the importance of renal biopsy to guide therapy. 2,9,10 The etiology of sarcoidosis has not yet been fully elucidated and different pathogenic and immunologic mechanisms have been discussed. Most likely, exposure to unknown organic or inorganic agents stimulates a local inflammation involving increased macrophage and CD4 helper T-cell activity leading to granuloma formation in various tissues.…”

Section: Discussionmentioning

confidence: 99%

Isolated Renal Relapse of Sarcoidosis under Low-Dose Glucocorticoid Therapy

et al. 2008

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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.

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“…Hypercalcemia and hypercalciuria are factors responsible for nephrolithiasis (11). Increased urinary excretion of beta-2 microglobulin may cause tubular damage (7). Although various types of glomerulonephritis are less commonly observed in patients with sarcoidosis, the disorder may present with symptoms and signs of MN, FSGS, diffuse mesangial proliferative glomerulonephritis, mesangio-capillary glomerulonephritis, IgA nephropathy, or crescentic glomerulonephritis.…”

Section: Türk Nefroloji Diyaliz Ve Transplantasyon Dergisi Turkish Nementioning

confidence: 99%

“…Sarcoidosis was detected after subsequent evaluations. In patients with MN associated with sarcoidosis, steroid therapy has been tried and successful results have been reported in the literature (7,12). While the treatment (Figure 3).…”

Section: Türk Nefroloji Diyaliz Ve Transplantasyon Dergisi Turkish Nementioning

confidence: 99%

Sarcoidosis Presenting with Membranous Nephropathy in a Patient with Hypertensive Nephropathy: Case Report

Turan¹,

Yaprak²,

Güngör³

et al. 2015

Turk Neph Dial Transpl

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Sarcoidosis is a systemic granulomatous disease that primarily involves the lung but may also have renal involvement. We present a hypertensive nephrosclerosis case found to have sarcoidosis after membranous nephropathy was diagnosed. A 57-year-old female patient was admitted due to nephrotic syndrome. She had a history of hypertension for 5 years. Fundus examination was consistent with grade 2 hypertensive retinopathy. Kidney biopsy was performed because of nephrotic syndrome and impaired renal function and revealed membranous nephropathy. Sarcoidosis was diagnosed while secondary causes of membranous nephropathy were investigated. Nephrotic syndrome was improved with steroid treatment in 6 months. In conclusion, a sarcoidosis case initially presenting with membranous nephropathy is an uncommon manifestation. Secondary causes of membranous nephropathy must be carefully investigated. kEy woRDS: Sarcoidosis, Nephrotic syndrome, Membranous nephropathy, Hypertensive nephropathy ÖzSarkoidoz başlıca akciğerler olmak üzere böbrek tutulumunun da görülebildiği granümatöz bir hastalıktır. Burada hipertansif nefrosklerozu olan, membranöz nefropati tanısı alıp sonradan sarkoidoz saptanan bir olgunun sunulması amaçlandı. 57 yaşında kadın hasta nefrotik sendrom kliniğiyle başvurdu. Hastanın öz geçmişinde 5 yıldır hipertansiyon öyküsü mevcuttu. Hastanın göz dibi bakısı grade II hipertansif retinopati ile uyumluydu. Nefrotik sendrom ve bozulmuş böbrek fonksiyonu nedeniyle yapılan böbrek biyopsisinde membranöz nefropati saptandı. Membranöz nefropatinin sekonder sebepleri araştırılırken hastaya sarkoidoz tanısı konuldu. Steroid tedavisiyle hastada 6 ayda tam remisyon sağlandı. Sonuç olarak, membranöz nefropati ile prezente olan sarkoidoz oldukça nadirdir. Her ne kadar membranöz nefropati sıklıkla idiopatik olsa da sekonder nedenler ısrarla araştırılmalıdır.

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Sarcoidosis with Membranous Nephropathy and Granulomatous Interstitial Nephritis.

Cited by 21 publications

References 8 publications

Granulomatous Interstitial Nephritis

Granulomatous Interstitial Nephritis

Isolated Renal Relapse of Sarcoidosis under Low-Dose Glucocorticoid Therapy

Sarcoidosis Presenting with Membranous Nephropathy in a Patient with Hypertensive Nephropathy: Case Report

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