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Abstract: TH-PO128

Renal Limited Sarcoidosis Presenting as Granulomatous Interstitial Nephritis

Session Information

  • AKI: Mechanisms - I
    November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

  • 103 AKI: Mechanisms

Authors

  • Sannapaneni, Shilpa, Baylor University Medical Center at Dallas, Dallas, Texas, United States
  • Damian, Louis, Baylor University Medical Center at Dallas, Dallas, Texas, United States
  • Hiser, Wesley, Baylor University Medical Center at Dallas, Dallas, Texas, United States
  • Akinfolarin, Akinwande A., Baylor University Medical Center at Dallas, Dallas, Texas, United States
Introduction

Sarcoidosis is a multisystem disorder which primarily involves the lung. Although, renal involvement can be seen in up to 35-50% of sarcoidosis patients, renal limited sarcoidosis without any extra renal manifestations is extremely rare. Here we present a unique case of renal limited sarcoidosis presenting with granulomatous interstitial nephritis (GIN).

Case Description

A 69-year-old female with a past medical history of type 2 diabetes, hypothyroidism, chronic obstructive pulmonary disease, chronic kidney disease with baseline creatinine of 1.1 mg/dL was referred to Nephrology with generalized weakness, nausea, vomiting. She had no skin rash, lymphadenopathy, hematuria, no recent history of systemic infections, or antibiotic use. Home medications included sitagliptin, levothyroxine, vitamin D and calcium supplements which were all started two years prior to referral.

On presentation, her vital signs were normal and physical examination was unremarkable. Laboratory studies revealed Creatinine 4.77 mg/dL, Calcium 15 mg/dL, Vitamin D 82 ng/ml; 1, 25 dihydroxy vitamin D 114 pg/ml, Parathyroid hormone (PTH) 16.9 pg/mL, PTH related peptide 18 pg/ml, Angiotensin converting enzyme level: 74 U/L, urine protein creatinine ratio: 0.3 mg/mg. Extensive infectious work-up was negative. Renal ultrasonography was unremarkable. A kidney biopsy was performed which was significant for acute interstitial nephritis, small granulomas with multinucleated giant cells concerning for granulomatous interstitial nephritis. Computed tomography scan of chest and abdomen showed no evidence of extra renal sarcoidosis. She was started on steroids and her creatinine trended down to 2.4 mg/dL at the time of discharge.

Discussion

Renal manifestations of sarcoid include nephrolithiasis, GIN, nephrocalcinosis, non-granulomatous interstitial nephritis and glomerular disease. GIN can be also seen with medications, infections, crystal deposition, paraproteinemias and vasculitis. GIN is a rare pathological diagnosis which may be seen in about 0.5-0.9% of native kidney biopsies and about 6% biopsies with interstitial nephritis. It is extremely rare to find GIN in sarcoidosis without extra renal involvement. A review of literature revealed about 100 cases of renal sarcoid associated GIN but majority had extra renal manifestations. The mainstay of therapy for sarcoidosis with GIN is steroids.