Renal Sarcoidosis

Sarcoidosis is a multisystem disease of unknown cause. Most often it affects young and middle-aged people. It is often manifested by bilateral hilar adenopathy, pulmonary infiltrates, and ocular and skin lesions. The liver, spleen, lymph nodes, salivary glands, heart, nervous system, muscles, bones and other organs may also be affected. Kidney damage is not common.

Epidemiology
Renal impairment is found in approximately 0.8% of patients. It does not occur in patients with Löfgren's syndrome.

Symptoms
The most common symptoms include nephrocalcinosis or nephrolithiasis. In 20% of patients with sarcoidosis, granulomatous inflammation in the renal parenchyma is present, but only rarely do clinically manifest like granulomatous ischemic nephritis or glomerular disease.

Treatment
For hypercalciuria, we choose measures to minimize the formation of stones. We provide adequate hydration, a diet with limited vitamin D (fish oils). Opinions differ on whether to recommend a Ca-poor diet. This is due to the lack of evidence of its effect on calcium homeostasis and the fact that increased intestinal absorption of oxalate occurs after dietary calcium restriction. In isolated hypercalciuria associated with nephrolithiasis without any indication for corticosteroids, thiazide diuretics should be tested before use.

In renal failure, treatment consists of rehydration, loop diuretics to promote renal Ca secretion, and  corticosteroids.

Related articles

 * Sarcoidosis (pathology)
 * Sarcoidosis (internal)

Resource

 * ANTON, Jan. Materiály k přednášce "Sarkoidóza".