King B P, Esparza A R, Kahn S I, Garella S
Arch Intern Med. 1976 Feb;136(2):241-5.
A woman had clinically isolated renal failure caused by granulomatous sarcoid nephritis. At the onset of her illness, there were no historical, physical, or clinical features to suggest a definite causative diagnosis. After a renal biopsy specimen disclosed noncaseating epithelioid granulomas, a course of steroid therapy resulted in prompt disappearance of uremic symptoms and amelioration of her renal failure. Although leukopenia, delayed cellular immunity, and the response to steroids increased the suspicion that the patient had sarcoidosis, it was not until identical granulomas were obtained via mediastinal node biopsy that the diagnosis was confirmed. Sarcoidosis may occur as isolated renal failure. Renal biopsy is indicated to ensure early diagnosis and prompt treatment of this steroid-responsive lesions.
一名女性因肉芽肿性结节病肾炎导致临床孤立性肾衰竭。在疾病发作时，没有病史、体格检查或临床特征提示明确的病因诊断。肾活检标本显示非干酪样上皮样肉芽肿后，类固醇治疗疗程使尿毒症症状迅速消失，肾衰竭得到改善。尽管白细胞减少、细胞免疫延迟以及对类固醇的反应增加了对患者患有结节病的怀疑，但直到通过纵隔淋巴结活检获得相同的肉芽肿，诊断才得以证实。结节病可能表现为孤立性肾衰竭。建议进行肾活检以确保对这种类固醇反应性病变进行早期诊断和及时治疗。
