Rizzato G, Colombo P
Sarcoid Clinic, Niguarda Hospital, Milan, Italy.
Sarcoidosis Vasc Diffuse Lung Dis. 1996 Sep;13(2):167-72.
The presentation of sarcoidosis with renal stones has never been evaluated in a prospective study.
We have studied 110 consecutive patients with histologically proven sarcoidosis, first seen in the years 1993-1994 in the Milan Sarcoid Clinic. Those who had renal stones preceding or suggesting the diagnosis of sarcoidosis, and those who had evidence of renal calculi at presentation, were studied up to 31 December 1995 with serial evaluation of calcaemia, calciuria and serum 1,25 (OH)2D3 and are the basis of this report.
Four patients had had calculi a long time ago and probably unrelated to their sarcoidosis. Three patients had a previous history of recurrent colic with calculi. In one further patient the occurrence of calculi suggested the diagnosis. In three other patients pyuria or microscopic haematuria at the presentation of pulmonary sarcoidosis led to the diagnosis of asymptomatic calculi. All the above seven patients had features of chronic disease and required long term corticosteroid therapy. Four of them required lithotripsy or pyelotomy before starting steroid therapy. Another had further calculi during the follow-up, and an episode of hydronephrosis requiring lithotripsy, due to poor compliance to corticosteroid therapy. Another patient had a single stone during follow-up in spite of proper therapy. In all the others prednisone was useful to control the disease. Summing up the results of a previous similar but retrospective study from our clinic, we can describe the full spectrum of nephrolithiasis at presentation of sarcoidosis, as it appears from the examination of 729 consecutive patients seen over 17 years (1978-1994), with a further follow-up of at least one year (see Conclusions).
结节病合并肾结石的表现从未在前瞻性研究中得到评估。
我们研究了110例经组织学证实的结节病患者，他们于1993 - 1994年首次在米兰结节病诊所就诊。那些在结节病诊断之前就有肾结石或提示结节病诊断的患者，以及那些在就诊时有肾结石证据的患者，在1995年12月31日前接受了血钙、尿钙和血清1,25(OH)₂D₃的系列评估，这些患者是本报告的基础。
4例患者很久以前就有结石，可能与他们的结节病无关。3例患者有复发性绞痛伴结石的病史。另有1例患者结石的出现提示了结节病的诊断。在另外3例患者中，肺部结节病就诊时的脓尿或镜下血尿导致了无症状结石的诊断。上述7例患者均有慢性病特征，需要长期使用皮质类固醇治疗。其中4例在开始使用类固醇治疗前需要进行碎石术或肾盂切开术。另1例患者在随访期间又出现结石，因对皮质类固醇治疗依从性差而发生肾积水，需要进行碎石术。另1例患者尽管接受了适当治疗，但在随访期间仍有单个结石。在所有其他患者中，泼尼松对控制疾病有效。总结我们诊所之前一项类似但为回顾性研究的结果，我们可以描述结节病就诊时肾结石的全貌，这是通过对17年（1978 - 1994年）间连续就诊的729例患者进行检查，并至少随访一年得出的（见结论）。
