Kuwae Noriko, Oshiro Yoko, Nakazato Satoshi
Department of Nephrology, Nakagami Hospital, Okinawa, Japan.
Nihon Jinzo Gakkai Shi. 2003;45(2):98-103.
We report sarcoidosis-related hypercalcemia in a patient undergoing hemodialysis, The patient, a 54-year-old woman, had been undergoing maintenance hemodialysis since 1989. The cause of end-stage renal disease was membranoproliferative glomerulonephritis. The patient was admitted to our hospital in January 2002 for the treatment of hypercalcemia(13.5 mg/dl), which was diagnosed in December 2001. Chest X-ray showed bilateral hilar lymphadenopathy, chest CT scan showed mediastinal lymph node swelling, and Ga-scintigraphy showed abnormal accumulation of gallium in the mediastinum. The patient's intact-PTH was 80-100 pg/ml. ACE(31.4 IU/l) and 1.25(OH)2D3(85 pg/ml) were elevated, and the bronchial lavage fluid CD4/CD8 ratio was slightly elevated. Epitheloid granulomatous tissue was obtained from a subclavian lymph node biopsy. Thus, the patient was diagnosed with sarcoidosis. The hypercalcemia and bilateral hilar lymphadenopathy improved with corticosteroid therapy.
我们报告了1例正在接受血液透析的患者发生结节病相关的高钙血症。该患者为一名54岁女性,自1989年以来一直在接受维持性血液透析。终末期肾病的病因是膜增生性肾小球肾炎。患者于2002年1月因治疗高钙血症(13.5mg/dl)入住我院,该高钙血症于2001年12月被诊断出来。胸部X线显示双侧肺门淋巴结肿大,胸部CT扫描显示纵隔淋巴结肿大,镓扫描显示镓在纵隔异常聚集。患者的全段甲状旁腺激素(intact-PTH)为80 - 100pg/ml。血管紧张素转换酶(ACE,31.4IU/l)和1,25-二羟维生素D3(1,25(OH)2D3,85pg/ml)升高,支气管灌洗液CD4/CD8比值略有升高。通过锁骨下淋巴结活检获得上皮样肉芽肿组织。因此,该患者被诊断为结节病。高钙血症和双侧肺门淋巴结肿大经皮质类固醇治疗后有所改善。