Dvoretsky Leonid, Sidoruk Nina, Krivushkin Sergey, Stepanchenko Andrey, Rachina Svetlana, Stolyarevich Ekaterina, de Silva Heshan Radeesha
I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
S.S. Yudin City Clinical Hospital, Moscow, Russian Federation.
Keio J Med. 2025 Jun 25;74(2):96-100. doi: 10.2302/kjm.2023-0020-CR. Epub 2025 Jan 29.
We describe a case of sarcoidosis in a previously healthy 39-year-old man with the development of an acute kidney injury, requiring renal replacement therapy, as the first manifestation of the disease. The course of the disease was complicated by a сatheter-associated bloodstream infection. According to the histological examination of kidney biopsy samples, granulomatous interstitial nephritis was diagnosed. Extensive examination of the patient revealed persistent hypercalcemia, elevated transaminase levels, intrathoracic lymphadenopathy, and infiltrates in the lungs. Other diseases, such as anti-neutrophil cytoplasmic antibody-associated vasculitis, tuberculosis, autoimmune liver diseases, and systemic lupus erythematosus, were ruled out. The patient was treated with pulse therapy of methylprednisolone, which then switched to oral glucocorticoids (prednisolone 60 mg/day followed by a gradual decrease in the dose). The 9-month follow-up revealed a regression of lung lesions and improvement of the impaired renal function. The prednisolone dose was reduced to 7.5 mg/day, and renal replacement therapy was discontinued.
我们描述了一例结节病病例，患者为一名39岁此前健康的男性，急性肾损伤为该疾病的首发表现，需要进行肾脏替代治疗。疾病过程中并发了导管相关血流感染。根据肾脏活检样本的组织学检查，诊断为肉芽肿性间质性肾炎。对患者进行的全面检查发现持续性高钙血症、转氨酶水平升高、胸内淋巴结病以及肺部浸润。排除了其他疾病，如抗中性粒细胞胞浆抗体相关性血管炎、结核病、自身免疫性肝病和系统性红斑狼疮。患者接受了甲泼尼龙冲击治疗，随后改为口服糖皮质激素（泼尼松龙60mg/天，随后逐渐减量）。9个月的随访显示肺部病变消退，肾功能受损情况改善。泼尼松龙剂量减至7.5mg/天，肾脏替代治疗停止。
