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We report a case of a 42-year old man who had cervical and bilateral hilar lymphadenopathy with elevated serum ACE level diagnosed by a private physician in February 2001. He was referred to Teikyo University Hospital because of bilateral hydronephrosis in April 2004, and underwent nephrostomy followed by retrograde ureteral stent replacement. As the biopsy specimens from skin and lung revealed non-caseating epithelioid cell granuloma, the diagnosis of sarcoidosis was confirmed in reference to increased serum levels of calcium, angiotensin converting enzyme and lysozyme. The findings of abdominal computed tomography showed that right nephrolithiasis and left ureteral compression by retroperitoneal lymphadenopathy were responsible for bilateral hydronephrosis. Treatment with prednisolone after extracorporeal shock wave lithotripsy reduced serum calcium and creatinine levels accompanied with an improvement of lymphadenopathy and hydronephrosis.
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