Kato Yuji, Taniguchi Narumi, Okuyama Mitsuhiko, Kakizaki Hidehiro
Department of Urology, Asahikawa Medical College, Asahikawa, Japan.
Int J Urol. 2007 Oct;14(10):954-6. doi: 10.1111/j.1442-2042.2007.01854.x.
We report three cases of urolithiasis associated with sarcoidosis and reviewed the Japanese published reports. All cases had hypercalcemia, hyperuricemia, hypercalciuria and renal dysfunction. A serum level of 1,25-(OH)2D3 was elevated and intact parathyroid hormone (PTH) was decreased. Stone components were predominantly calcium oxalate. Abnormal calcium metabolism is a well-known feature of sarcoidosis and the reported prevalence of urolithiasis in patients with sarcoidosis was 1.3-14.0% in the English published reports. However, urolithiasis associated with sarcoidosis is uncommon in Japan and we could find only 16 documented cases including ours. Abnormal calcium metabolism is caused by an increase in serum concentration of 1,25-(OH)2D3, which is derived from endogenous overproduction in the pulmonary macrophages. If patients with urolithiasis have abnormal calcium metabolism, renal impairment and suppression of PTH, the possibility of sarcoidosis should be considered for a differential diagnosis. Also, it should be emphasized that the presence or developing of urolithiasis is to be monitored during follow up of patients with sarcoidosis.
我们报告了3例与结节病相关的尿石症病例，并回顾了日本已发表的报告。所有病例均有高钙血症、高尿酸血症、高钙尿症和肾功能不全。血清1,25-(OH)2D3水平升高，而完整甲状旁腺激素（PTH）降低。结石成分主要为草酸钙。钙代谢异常是结节病的一个众所周知的特征，在英文发表的报告中，结节病患者尿石症的报告患病率为1.3%-14.0%。然而，在日本，与结节病相关的尿石症并不常见，我们仅能找到包括我们病例在内的16例有记录的病例。钙代谢异常是由血清1,25-(OH)2D3浓度升高引起的，其源于肺巨噬细胞内源性过度产生。如果尿石症患者有钙代谢异常、肾功能损害和PTH抑制，应考虑结节病的可能性以进行鉴别诊断。此外，应强调在结节病患者的随访过程中要监测尿石症的存在或发展情况。
