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Nephrology Grand Rounds

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Title: Nephrology Grand Rounds Author: Test Last modified by: Ehrman Medical Library Created Date: 6/14/2008 5:14:09 PM Document presentation format – PowerPoint PPT presentation

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Title: Nephrology Grand Rounds


1
Nephrology Grand Rounds
  • 6/17/08

2
Sarcoidosis in the kidney
  • Brad Weaver

3
Sarcoidosis
  • Multisystem heterogeneous disease of unknown
    etiology characterized by noncaseating granulomas
  • Three to four times more common among blacks
  • Most often presents between ages 10-40
  • Common symptoms
  • Cough
  • Skin lesions
  • Eye lesions
  • Systemic fatigue, malaise, fever, and weight
    loss
  • CXR often shows b/l hilar adenopathy and/or
    pulmonary reticular opacities

4
Organ involved
Lungs 699 95.0
Skin   117 15.9
Lymph node 112 15.2
Eye 87 11.8
Liver 85 11.5
Erythema nodosum 61 8.3
Spleen 49 6.7
Neurologic 34 4.6
Parotid/salivary 29 3.9
Bone marrow 29 3.9
Calcium 27 3.7
ENT 22 3.0
Cardiac 17 2.3
Renal 5 0.7
Bone/joint 4 0.5
Muscle 3 0.4
Am J Respir Crit Care Med 20011641885.
5
Lab findings in sarcoidosis
  • Eosinophilia 25
  • Leukopenia 5-10
  • Hypergammaglobulinemia 30-80
  • Elevated serum ACE level 75. False positives
    are rare.
  • BAL showing increased CD4/CD8 ratio
  • Hypercalcemia 2/2 extrarenal production of
    calcitriol by activated macrophages
  • Hypercalciuria is reported to be more common than
    hypercalcemia

6
Renal involvement
  • Sarcoidosis can cause wide variety of renal
    disease including ESRD
  • Histologic changes are more common than clinical
    disease which is rare
  • 20-50 on several small series of kidney biopsies
    and postmortem analysis
  • Nephrolithiasis may be the presenting symptom
    of sarcoidosis
  • Polyuria
  • Nephrogenic DI 2/2 hypercalcemia
  • Central DI 2/2 granulomas in hypothalamus (also
    can cause primary polydipsia)

7
Granulomatous acute interstitial nephritis
Granuloma
Interstitial Inflammation
8
Retrospective study
  • 40 cases of renal granulomas found on kidney
    biopsy
  • Etiologies were determined
  • Sarcoidosis 20 (50)
  • Drug-induced 7 (17.5)
  • TB 3 (7.5)
  • Wegeners 2 (5)
  • Leprosy 1 (2.5)
  • Mycobacterium avium 1 (2.5)
  • Crohns disease 1 (2.5)
  • No etiology determined 5 (12.5)

Medicine (Baltimore). 2007 May86(3)170-80.
9
Renal involvement cont.
  • Glomerular disease case reports of membranous,
    proliferative crescentic GN, FSGS
  • Urinary tract obstruction
  • Nephrolithiasis
  • RP fibrosis
  • RP lymph node enlargement
  • Treatment prednisone 1mg/kg/day
  • Transplant has been reported to be successful

10
TINU syndrome
  • Tubulointerstitial nephritis uveitis (TINU)
    rare disorder thought to be related to
    sarcoidosis
  • About 140 cases have been reported in mainly
    adolescents young women
  • Renal disease can present as flank pain, sterile
    pyuria, acute renal failure often resolve on
    its own
  • Cases of progressive renal failure have been
    treated w/ 3-6 mo. of prednisone
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