Kikuchi Hiroaki, Mori Takayasu, Rai Tatemitsu, Uchida Shinichi
Department of Nephrology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
CEN Case Rep. 2015 Nov;4(2):212-217. doi: 10.1007/s13730-015-0171-4. Epub 2015 Mar 5.
Granulomatous interstitial nephritis (GIN) is one of the renal pathological manifestations of sarcoidosis. It is usually clinically silent, but may present occasionally as acute kidney injury (AKI). AKI caused by sarcoid GIN without extrarenal manifestations is extremely rare. We report a case of a 70-year-old man with a history of type 2 diabetes mellitus admitted with progressively worsening kidney function. The patient also exhibited anorexia, malaise and weight loss. Laboratory tests showed an elevated serum lysozyme level, but the serum angiotensin-converting enzyme (ACE) and serum calcium levels were normal. Increased uptake was evident only in kidney on gallium 67 scintigraphy. Although typical organ involvement of sarcoidosis was not evident, a renal biopsy showed granulomatous interstitial nephritis with non-caseating granulomas. No medications had been added in the 3 years preceding renal function deterioration. Following a bronchoalveolar lavage that revealed a high CD4:CD8 ratio, and a skin test that showed negative for tuberculin, a diagnosis of renal sarcoidosis was established. On diagnosis, oral prednisolone was initiated and renal function improved. The anorexia and malaise also disappeared. This is the extremely rare case of AKI caused by sarcoid GIN without extrarenal manifestations or elevated serum ACE level.
肉芽肿性间质性肾炎(GIN)是结节病的肾脏病理表现之一。它通常在临床上无明显症状,但偶尔可能表现为急性肾损伤(AKI)。由结节病性GIN引起的无肾外表现的AKI极为罕见。我们报告一例70岁男性,有2型糖尿病病史,因肾功能进行性恶化入院。患者还出现厌食、乏力和体重减轻。实验室检查显示血清溶菌酶水平升高,但血清血管紧张素转换酶(ACE)和血清钙水平正常。镓67闪烁扫描仅在肾脏显示摄取增加。尽管结节病的典型器官受累不明显,但肾活检显示为非干酪样肉芽肿性间质性肾炎。在肾功能恶化前3年未加用任何药物。支气管肺泡灌洗显示CD4:CD8比值升高,结核菌素皮肤试验阴性,确诊为肾结节病。确诊后,开始口服泼尼松龙,肾功能改善。厌食和乏力也消失了。这是一例极为罕见的由结节病性GIN引起的无肾外表现或血清ACE水平升高的AKI病例。