Takizawa H, Ohta K, Kobayashi N, Ishii A, Suzuki S, Okudaira H, Miyamoto T, Ito K
Department of Medicine and Physical Therapy, University of Tokyo School of Medicine, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1992 Apr;30(4):648-52.
A 62-year-old woman presented with uveitis and abnormal chest X-ray (bilateral hilar adenopathy). Skin biopsy in 1983 had revealed non-caseating epithelioid cell granuloma consistent with sarcoidosis. Her serum biochemical investigations and exploratory laparoscopy suggested nodular liver cirrhosis, but biopsy was not performed. Both blood urea nitrogen (BUN) and serum creatinine values were within normal limits. She received prednisolone therapy of 15 mg daily initially, and later a maintenance dose of 5 mg daily. In 1985, she complained of skin itching and her laboratory data revealed severe renal insufficiency (BUN 97 mg/dl, serum creatinine 12.2 mg/dl) and hypercalcemia (corrected serum calcium level: 11.5 mg/dl). Prednisolone treatment (40 mg daily) resulted in a dramatic improvement of renal function as well as other clinical abnormalities due to sarcoidosis, without any significant changes in liver function. She died of cerebral infarction in 1989. Autopsy showed interstitial nephritis with tubular calcinosis and hyalinized glomeruli. It is postulated that hypercalcemia due to sarcoidosis contributed to the renal failure in this patient. This case suggests that renal damage due to sarcoidosis may be reversible with appropriate corticosteroid therapy.
一名62岁女性因葡萄膜炎和胸部X线异常（双侧肺门淋巴结肿大）就诊。1983年的皮肤活检显示非干酪样上皮样细胞肉芽肿，符合结节病。她的血清生化检查和 exploratory laparoscopy（此处可能有误，推测为“腹腔镜检查”）提示结节性肝硬化，但未进行活检。血尿素氮（BUN）和血清肌酐值均在正常范围内。她最初接受每日15毫克泼尼松龙治疗，后来维持剂量为每日5毫克。1985年，她主诉皮肤瘙痒，实验室检查显示严重肾功能不全（BUN 97毫克/分升，血清肌酐12.2毫克/分升）和高钙血症（校正血清钙水平：11.5毫克/分升）。泼尼松龙治疗（每日40毫克）使肾功能以及结节病引起的其他临床异常情况显著改善，肝功能无明显变化。她于1989年死于脑梗死。尸检显示间质性肾炎伴肾小管钙化和肾小球玻璃样变。据推测，结节病引起的高钙血症导致了该患者的肾衰竭。该病例表明，结节病所致的肾损害通过适当的皮质类固醇治疗可能是可逆的。
