Manes M, Molino A, Gaiter A, Alloatti S
Servizio di Nefrologia e Dialisi, Ospedale Regionale della Valle d'Aosta.
Recenti Prog Med. 2000 Sep;91(9):441-3.
A 59-years-old male patient was admitted to our Service because of acute renal failure with maintained diuresis (creatinine at admittance 6.2 mg/dl), preceded by malaise and weight loss. Clinical examination was normal and no investigation lead to a sure differential diagnosis of acute renal failure. The only abnormal laboratory investigations were: marked hypercalcaemia (12.7 mg/dl), slightly depressed parathormone (10 pg/ml) and anemia (Hb 11.2 g/dl). Also instrumental investigations performed were inexpressive. The abrupt appearance of an unilateral 7th cranial nerve paralysis lead to start a steroid therapy followed, in some days, by the normalization of calcium level and by a partial improvement of renal function. A renal biopsy was finally performed which permitted the diagnosis of interstitial granulomatous nephritis according to a sarcoidosis disease. Steroid therapy was continued allowing to a progressive, although not complete, recovery of renal function. The case peculiarity consists of isolated renal lesions with a severe expression of renal disease. The absence of classical disease criteria (pulmonary involvement firstly), in our case total body Gallium-67 scintigraphy was normal, should not exclude the diagnosis of sarcoidosis. The authors underline the importance of renal biopsy in detecting interstitial renal lesions potentially leading to uremia.
一名59岁男性患者因急性肾衰竭伴持续利尿（入院时肌酐为6.2mg/dl）入院，此前有全身不适和体重减轻症状。临床检查正常，各项检查均未明确急性肾衰竭的鉴别诊断。唯一异常的实验室检查结果为：明显高钙血症（12.7mg/dl）、甲状旁腺素轻度降低（10pg/ml）和贫血（血红蛋白11.2g/dl）。影像学检查结果也无明显异常。单侧第七颅神经麻痹的突然出现促使开始使用类固醇治疗，数日后血钙水平恢复正常，肾功能部分改善。最终进行了肾活检，根据结节病诊断为间质性肉芽肿性肾炎。继续使用类固醇治疗，肾功能逐渐恢复，虽未完全恢复。该病例的特点是孤立性肾脏病变且肾病表现严重。在我们的病例中，全身镓-67闪烁扫描正常，缺乏典型的疾病标准（首先是肺部受累），但这不应排除结节病的诊断。作者强调了肾活检在检测可能导致尿毒症的间质性肾病变中的重要性。
