Hypercalcemia-induced acute kidney injury in a Caucasian female due to radiographically silent systemic sarcoidosis.

Clinical Nephrology. Case Studies Pub Date : 2018-09-04 eCollection Date: 2018-01-01 DOI:10.5414/CNCS109513
Ramy M Hanna, Marian Kaldas, Farid Arman, Melissa Wang, Terrance Hammer, Deren Sinkowitz, Anjay Rastogi
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引用次数: 3

Abstract

. Sarcoidosis is a rare autoimmune disease resulting in formation of non-necrotizing "non-caseating" granulomas generally in the lung. The disease classically strikes African American females in their fourth and fifth decades. The resulting hypercalcemia is a result of 1-α hydroxylase overexpression in granulomas with increased 1,25-dihydroxy vitamin D levels. This phenomenon can also be observed in mycobacterial and fungal infections that produce granulomas in infected patients. Thus, chronic infectious diseases are part of differential diagnosis of granulomatous processes. We present an elderly Caucasian female who presented with hypercalcemia with serum calcium of 11 - 14 mg/dL and an elevated ionized calcium of 1.4 - 1.5 mmol/L. Initially cholecalciferol supplements were stopped, but hypercalcemia persisted for more than 2 months. 1,25-dihydroxy vitamin D levels were markedly elevated with low normal 25-hydroxy vitamin D levels, angiotensin-converting enzyme levels were also high, and chest computed tomography (CT) imaging was negative for any lymphadenopathy (including perihilar lymphadenopathy). Malignancy and infectious workups were negative for fungal and mycobacterial infections. Positron emission tomography revealed several small lymph nodes in right upper lobe of lung, and biopsy of bone marrow and lung lymph-nodes revealed non-caseating granulomata. We present an atypical case of occult sarcoidosis presenting mainly with biochemical findings without any definitive imaging findings, making diagnosis a clinical challenge.

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高钙血症引起的急性肾损伤的白种人女性由于放射学沉默系统性结节病。
。结节病是一种罕见的自身免疫性疾病,通常在肺部形成非坏死性“非干酪化”肉芽肿。这种疾病通常发生在40岁和50岁的非裔美国女性身上。由此产生的高钙血症是1-α羟化酶在肉芽肿中过度表达的结果,而肉芽肿的1,25-二羟基维生素D水平升高。这种现象也可以在分枝杆菌和真菌感染中观察到,这些感染产生肉芽肿。因此,慢性感染性疾病是肉芽肿过程鉴别诊断的一部分。我们报告了一位老年高加索女性,她表现为高钙血症,血清钙为11 - 14 mg/dL,离子钙升高为1.4 - 1.5 mmol/L。最初停止补充胆钙化醇,但高钙血症持续超过2个月。1,25-二羟基维生素D水平明显升高,正常25-羟基维生素D水平较低,血管紧张素转换酶水平也较高,胸部计算机断层扫描(CT)未见任何淋巴结病(包括门周淋巴结病)。恶性肿瘤和感染性检查均未发现真菌和分枝杆菌感染。正电子发射断层扫描示右肺上叶若干小淋巴结,骨髓及肺淋巴结活检示非干酪化肉芽肿。我们报告一个不典型的隐性结节病病例,主要表现为生化检查,没有任何明确的影像学检查,使诊断成为临床挑战。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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