A Case of Sarcoidosis Associated with Hypercalcemia and Rapidly Progressive Renal Dysfunction

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A case of sarcoidosis with hypercalcemia and rapidly progressive renal dysfunction is reported. A 71 year-old-female, having been treated for sarcoidosis with no symptoms since 1991, was admitted in July, 1997, for anorexia, elevated levels of serum calcium, and creatinine. Urinalysis showed proteinuria and hematuria. Decreased GFR, and disturbances in tubular function were revealed by renal function tests. The serum ACE level was normal, although the serum lysozyme level was elevated. The serum 1 α 25(OH)2D3 level was high for her age and osteoporosis. Both serum intact PTH and PTHrP levels were normal. BHL remained on chest X-ray film and slight accumulations of 67Ga-citrate were observed in bilateral hilar regions and kidneys by 67Ga scintigraphy. Diet therapy, infusion and diureticus gradually normalized her serum calcium, creatinine and 1 α 25(OH)2D3 levels. Steroid was not administered considering her age, hyperlipidemia and hypertension, although a renal biopsy revealed interstitial nephritis. In this case, hypercalcemia seems to have caused the progression of renal dysfunction induced by sarcoid nephronathy.
日本サルコイドーシス/肉芽腫性疾患学会の論文