Two male patients ages 12 and 18 years presented with severe renal functional impairment occurring during the course of untreated sarcoidosis.
Renal manifestations were acute in the younger patient and chronic (4 mo.) in the older. On admission, serum creatinines (S Cr) were 6.1 and 12 mg/dl, serum calciums 10 and 10.2 mEq/L and hematocrits 29 and 2 8% respectively. Neither course was characterized by hypertension or oliguria. Urinary protein excretions were 1.4 and 1 gm/24 hrs. and the sediments were normal. IVP revealed normal size kidneys without calcifications. Renal biopsies in both revealed severe interstitial nephritis without calcium or granulomata. No glomerular disease was present in the younger patient, while 12 of 24 glomeruli were sclerotic in the older. Immunoglobulins were not present. Prednisone therapy 60 mg q.d. induced a complete remission of renal disease within 3 weeks in the younger patient (S Cr 0.8 mg/dl) and a significant improvement with S Cr diminishing to 5.7 mg/dl within 3 months, in the older patient.
Our experience indicates that the previously unreported etiology of acute renal failure in sarcoidosis, acute interstitial nephritis, can be successfully treated with prednisone.
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Abularrage, J., Szer, I., Matthews, M. et al. 1042 INTERSTITIAL NEPHRITIS, A REVERSIBLE CAUSE OF RENAL FAILURE IN SARCOIDOSIS. Pediatr Res 12, 537 (1978). https://doi.org/10.1203/00006450-197804001-01048