Medizinische Klinik A, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany.
Klinik für Innere Medizin II, Krankenhaus der barmherzigen Brüder and KfH-Nierenzentrum, Nordallee, Trier, Germany.
Respir Med. 2023 Apr;209:107121. doi: 10.1016/j.rmed.2023.107121. Epub 2023 Jan 18.
Sarcoidosis is a systemic granulomatous disease potentially affecting every organ system. Renal involvement is reportedly rare, and the evidence consists of case reports and cohort studies. Systematic investigations are scarce and show a varying prevalence ranging from <1% to 30-50%.
We retrospectively analyzed data from patients with a recent diagnosis of sarcoidosis from five tertiary care centers focusing on renal sarcoidosis.
We analyzed data from 327 patients with sarcoidosis between 2001 and 2021. Of 327 patients, 109 (33.3%) had probable or definite renal sarcoidosis. 90 (27.5%) had histopathologic confirmation. 57 (64%) had an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m. The most prominent associated finding was an elevated soluble interleukin-2 receptor. Patients with renal sarcoidosis more frequently received glucocorticoids than other non-renal sarcoidosis patients (92% vs. 78%, p < 0.01). Also, azathioprine (38% vs. 16%, p < 0.001) and mycophenolate mofetil (5% vs. 1%, p < 0.05) were more frequently used in renal sarcoidosis compared to non-renal sarcoidosis, whereas methotrexate was used less frequently (7% vs. 17%, p < 0.05).
Our data of the largest cohort with biopsy-confirmed renal sarcoidosis demonstrate a higher prevalence (27.5% of all patients) than previously published with a relevant disease burden. The urinary findings in most cases were only mildly abnormal, and some patients did not have renal biopsy despite abnormal urinary results. A renal workup should be performed in all patients with a new diagnosis of sarcoidosis.
结节病是一种全身性肉芽肿性疾病，可能影响所有器官系统。据报道，肾脏受累罕见，证据包括病例报告和队列研究。系统研究很少，患病率从<1%到 30-50%不等。
我们回顾性分析了来自五个三级护理中心的最近诊断为结节病的患者的数据，重点是肾结节病。
我们分析了 2001 年至 2021 年期间 327 例结节病患者的数据。在 327 例患者中，109 例（33.3%）有明确或可能的肾结节病。90 例（27.5%）有组织病理学证实。57 例（64%）肾小球滤过率（eGFR）<60ml/min/1.73m。最突出的相关发现是可溶性白细胞介素-2 受体升高。与其他非肾结节病患者相比，肾结节病患者更常接受糖皮质激素治疗（92%比 78%，p<0.01）。此外，与非肾结节病相比，肾结节病患者更常使用硫唑嘌呤（38%比 16%，p<0.001）和霉酚酸酯（5%比 1%，p<0.05），而甲氨蝶呤的使用较少（7%比 17%，p<0.05）。
我们的数据来自最大的活检证实的肾结节病队列，患病率（所有患者的 27.5%）高于先前的报道，且疾病负担较重。大多数情况下，尿液发现仅轻度异常，一些患者尽管尿液结果异常仍未进行肾活检。所有新诊断为结节病的患者都应进行肾脏检查。
