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Rev Med Interne. 2013 Sep;34(9):538-44. doi: 10.1016/j.revmed.2012.10.009. Epub 2012 Nov 13.

[Kidney involvement in sarcoidosis].

[Article in French]

Author information

1
Inserm U955, service de néphrologie et transplantation, université Paris Est, hôpital Henri-Mondor, institut francilien de recherche en néphrologie et transplantation (IFRNT), AP-HP, 94010 Créteil, France. thstehle@gmail.com

Abstract

Sarcoidosis is a chronic multisystemic inflammatory disorder of unknown etiology, characterized by the presence of non-necrotizing epithelioid and giant cell granulomas. Various renal manifestations have been reported in patients with sarcoidosis. Disorders of bone and mineral metabolism related to the overexpression of 25-hydroxyvitamin-D1α-hydroxylase by alveolar and granuloma macrophages are frequently associated with sarcoidosis. Hypercalcemia and hypercalciuria are a major cause of renal injury predisposing to pre renal azotemia, acute tubular necrosis, nephrolithiasis and nephrocalcinosis. Therapeutic management of hypercalcemia includes preventive measures (limited sunlight exposure, limited vitamin D and calcium intakes, and adequate hydration) and specific treatment in cases of severe hypercalcemia (corticosteroid therapy, chloroquine or ketoconazole). Granulomatous tubulointerstitial nephritis is the most common renal lesion associated with sarcoidosis leading to end stage renal disease in some patients. In these cases, interstitial fibrosis seems to appear early in the course of sarcoidosis and is a major prognostic factor requiring rapid corticosteroid therapy to reduce the risk of severe renal impairment. Membranous nephropathy seems to be the most frequent glomerular disease that may occur in association with sarcoidosis. Among kidney allograft recipients, the risk of recurrence of granulomatous tubulointerstitial nephritis is high and may have a negative impact on the graft survival.

KEYWORDS:

Calcium homeostasis; Glomerular disease; Granulomatous interstitial nephritis; Homéostasie calcique; Maladie glomérulaire; Néphrite interstitielle granulomateuse; Sarcoidosis; Sarcoïdose

PMID:
23154110
DOI:
10.1016/j.revmed.2012.10.009
[Indexed for MEDLINE]

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