Abstract: PUB094
When the Kidneys Speak First: A Rare Case of Renal-Limited Granulomatous Disease
Session Information
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Saeed, Wajeeha, The University of New Mexico Department of Internal Medicine, Albuquerque, New Mexico, United States
- de Leoz, Josephine B., The University of New Mexico Department of Internal Medicine, Albuquerque, New Mexico, United States
Introduction
Sarcoidosis is a multisystem inflammatory disease of unknown etiology. Characterized by non-caseating granulomas (clumps of immune cells). Primarily affects the lungs (90%+) and lymph nodes. It can involve almost any organ system. Renal involvement in sarcoidosis occurs in approximately 10% to 50% of patients, though clinically significant renal disease is less common. While granulomatous interstitial nephritis (GIN) is often silent, renal abnormalities, such as kidney stones or nephrocalcinosis, occur in roughly 5%–14% of patients, and serious acute kidney injury (AKI) occurs in less than 1%.
Case Description
73-year-old male with a history of HTN and HLD admitted to the hospital for polyuria for the last 2 weeks and weight loss. Initial lab findings showed significant hypercalcemia with suppressed iPTH. Ca 14.2, iCa 1.48, iPTH 7, Calcitriol 71.8, low D3, PTHrP of 2.5, ACE level of < 10, and Cr 1.64 with baseline Cr 1.2. CT Chest was notable for axillary adenopathy and a 6 mm right middle lobe pulmonary nodule; biopsy of the right axillary lymph node was negative for malignancy but showed non-necrotizing granulomatous inflammation. Diagnosis of Sarcoidosis was primarily entertained. Initial management included IV fluids, Zoledronic acid, and Calcitonin. Patient was discharged with improved Ca of 8.9 mg/dl. Since there was no pulmonary involvement of sarcoidosis, steroid treatment was not started. He was readmitted for persistent polyuria, recurrence of hypercalcemia (13.3), and AKI (Cr 2.64). He received aggressive fluid resuscitation, and a renal biopsy showed ATI with foci of granulomatous tubulointerstitial nephritis. He was started on Prednisone 20 mg due to renal involvement of sarcoidosis. The patient was discharged with significant improvement in polyuria and resolution of AKI, with normal serum Ca (Cr 1.21 mg/dl, Ca 9.6 mg/dl).
Discussion
Renal sarcoidosis is a rare but significant complication of systemic sarcoidosis. Early diagnosis and corticosteroid therapy are essential to preventing renal failure. In order to reduce the long-term reliance on corticosteroids; future medical treatment for renal sarcoidosis is shifting toward targeted biological therapies and pathway-specific inhibitors.For now, Glucocorticoids remain the first-line standard of care; research is actively exploring ways to personalize treatment and minimize side effects.