Renal confined sarcoidosis: Natural history and diagnostic challenge

A 69 year old male referred to nephrology clinic for uncontrolled hypertension. During his follow up over two years, he developed renal disease and hypercalcemia. He was found to have monoclonal gammopathy (MGUS). Urinalysis was negative except for Monoclonal IgG on immunoelectrophoresis. Workup for...

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Autores principales:	Azam Ghafoor, Akram Almakki
Formato:	article
Lenguaje:	EN
Publicado:	Thieme Medical and Scientific Publishers Pvt. Ltd. 2014
Materias:	hypercalcemia monoclonal gammopathy of undetermined significance renal-confined sarcoidosis Medicine R
Acceso en línea:	https://doaj.org/article/18e4ae8f797c4629a1676b259878199a
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spelling	oai:doaj.org-article:18e4ae8f797c4629a1676b259878199a2021-12-02T16:34:42ZRenal confined sarcoidosis: Natural history and diagnostic challenge2231-07702249-446410.4103/2231-0770.130346https://doaj.org/article/18e4ae8f797c4629a1676b259878199a2014-04-01T00:00:00Zhttp://www.thieme-connect.de/DOI/DOI?10.4103/2231-0770.130346https://doaj.org/toc/2231-0770https://doaj.org/toc/2249-4464A 69 year old male referred to nephrology clinic for uncontrolled hypertension. During his follow up over two years, he developed renal disease and hypercalcemia. He was found to have monoclonal gammopathy (MGUS). Urinalysis was negative except for Monoclonal IgG on immunoelectrophoresis. Workup for malignancy was negative including chest X-ray and bone marrow biopsy. He progressed into renal failure and ended up on dialysis. Interestingly, the renal biopsy showed non-caseating granulomas, and the patient was diagnosed with renal confined sarcoidosis which is extremely rare. PPD was negative. He was treated with Prednisone 60 mg daily. Surprisingly, his kidney disease was not responsive to steroids. Despite improvement in his calcium with treatment, his kidney function did not improve and he remained on hemodialysis but needed to stay on small dose of Prednisone to keep his calcium under control. Our case is the first in the literature that demonstrates the natural history of renal-confined sarcoidosis. In addition, the presence of MGUS created a diagnostic challenge and delayed diagnosis of sarcoidosis. Although the renal biopsy did not show direct damage from MGUS, a potential relation between renal sarcoidosis and MGUS is worth studied.Azam GhafoorAkram AlmakkiThieme Medical and Scientific Publishers Pvt. Ltd.articlehypercalcemiamonoclonal gammopathy of undetermined significancerenal-confined sarcoidosisMedicineRENAvicenna Journal of Medicine, Vol 04, Iss 02, Pp 44-47 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	hypercalcemia monoclonal gammopathy of undetermined significance renal-confined sarcoidosis Medicine R
spellingShingle	hypercalcemia monoclonal gammopathy of undetermined significance renal-confined sarcoidosis Medicine R Azam Ghafoor Akram Almakki Renal confined sarcoidosis: Natural history and diagnostic challenge
description	A 69 year old male referred to nephrology clinic for uncontrolled hypertension. During his follow up over two years, he developed renal disease and hypercalcemia. He was found to have monoclonal gammopathy (MGUS). Urinalysis was negative except for Monoclonal IgG on immunoelectrophoresis. Workup for malignancy was negative including chest X-ray and bone marrow biopsy. He progressed into renal failure and ended up on dialysis. Interestingly, the renal biopsy showed non-caseating granulomas, and the patient was diagnosed with renal confined sarcoidosis which is extremely rare. PPD was negative. He was treated with Prednisone 60 mg daily. Surprisingly, his kidney disease was not responsive to steroids. Despite improvement in his calcium with treatment, his kidney function did not improve and he remained on hemodialysis but needed to stay on small dose of Prednisone to keep his calcium under control. Our case is the first in the literature that demonstrates the natural history of renal-confined sarcoidosis. In addition, the presence of MGUS created a diagnostic challenge and delayed diagnosis of sarcoidosis. Although the renal biopsy did not show direct damage from MGUS, a potential relation between renal sarcoidosis and MGUS is worth studied.
format	article
author	Azam Ghafoor Akram Almakki
author_facet	Azam Ghafoor Akram Almakki
author_sort	Azam Ghafoor
title	Renal confined sarcoidosis: Natural history and diagnostic challenge
title_short	Renal confined sarcoidosis: Natural history and diagnostic challenge
title_full	Renal confined sarcoidosis: Natural history and diagnostic challenge
title_fullStr	Renal confined sarcoidosis: Natural history and diagnostic challenge
title_full_unstemmed	Renal confined sarcoidosis: Natural history and diagnostic challenge
title_sort	renal confined sarcoidosis: natural history and diagnostic challenge
publisher	Thieme Medical and Scientific Publishers Pvt. Ltd.
publishDate	2014
url	https://doaj.org/article/18e4ae8f797c4629a1676b259878199a
work_keys_str_mv	AT azamghafoor renalconfinedsarcoidosisnaturalhistoryanddiagnosticchallenge AT akramalmakki renalconfinedsarcoidosisnaturalhistoryanddiagnosticchallenge
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Renal confined sarcoidosis: Natural history and diagnostic challenge

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