6/17/08
Brad Weaver
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
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 2001;164:1885.
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
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)
Granulomatous acute interstitial nephritis
Granuloma
Interstitial Inflammation
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%)
 Wegener’s 2 (5%)
 Leprosy 1 (2.5%)
 Mycobacterium avium 1 (2.5%)
 Crohn’s disease 1 (2.5%)
 No etiology determined 5 (12.5%)
Medicine (Baltimore). 2007 May;86(3):170-80.
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
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