A Case of Sarcoidosis Associated with Hypercalcemia and Rapidly Progressive Renal Dysfunction

Abstract

A case of sarcoidosis with hypercalcemia and rapidly progressive renal dysfunction is reported. A 71 year-old-female, having been treated for sarcoidosis with no symptoms since 1991, was admitted in July, 1997, for anorexia, elevated levels of serum calcium, and creatinine. Urinalysis showed proteinuria and hematuria. Decreased GFR, and disturbances in tubular function were revealed by renal function tests. The serum ACE level was normal, although the serum lysozyme level was elevated. The serum 1 α 25(OH)₂D₃ level was high for her age and osteoporosis. Both serum intact PTH and PTHrP levels were normal. BHL remained on chest X-ray film and slight accumulations of ⁶⁷Ga-citrate were observed in bilateral hilar regions and kidneys by ⁶⁷Ga scintigraphy. Diet therapy, infusion and diureticus gradually normalized her serum calcium, creatinine and 1 α 25(OH)₂D₃ levels. Steroid was not administered considering her age, hyperlipidemia and hypertension, although a renal biopsy revealed interstitial nephritis. In this case, hypercalcemia seems to have caused the progression of renal dysfunction induced by sarcoid nephronathy.