Sarcoid tubulo-interstitial nephritis: Long-term outcome and response to corticosteroid therapy

Sarcoid tubulo-interstitial nephritis: Long-term outcome and response to corticosteroid therapy,10.1038/,Kidney International,R Rajakaria

Sarcoid tubulo-interstitial nephritis: Long-term outcome and response to corticosteroid therapy   (Citations: 14)
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Sarcoidosis is a chronic relapsing multi-systemic disorder characterized by the development of non-caseating granulomas. Granulomatous tubulo-interstitial nephritis is an uncommon manifestation of this condition. We identified 39 patients with sarcoidosis and renal disease from a single center of whom 17 patients had biopsy-proven tubulo-interstitial nephritis. They were analyzed with respect to demographic and clinical features, including response to corticosteroids and length of follow-up. They all presented with significant renal impairment. At presentation the mean±s.d. estimated glomerular filtration rate (eGFR) was 26.8±14 ml/min by modification of diet in renal disease (MDRD) equation 7. With treatment there was a significant improvement in renal function with eGFR 49.6±5.2 ml/min (P<0.01) at 1 year, and 47.9±6.8 ml/min (P<0.05) at the last review. The median follow-up was 84 months (range 6–284 months). Patients with chronic kidney disease (CKD) 3, the mean eGFR was 38.30±2.4 ml/min at presentation and 60.2±7.4 ml/min at 1 year (P=0.02) and in CKD 4 it improved from 19±2 to 38±6.6 ml/min at 1 year (P<0.05). After the 1st year, the change in eGFR was +0.8 ml/min/year for CKD 3 and −2 ml/min/year for CKD 4 (P<0.05). Three patients ceased their therapy either due to complications or poor compliance and experienced a worsening of renal function which was then reversed on re-commencing corticosteroids. Corticosteroids are effective in advanced tubulo-interstitial nephritis due to sarcoidosis. Long-term treatment is necessary to preserve renal function and to delay the onset of end-stage renal disease.
Journal: Kidney International - KIDNEY INT , vol. 70, no. 1, pp. 165-169, 2006
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    • ...Granulomatous interstitial nephritis is another typical renal manifestation of active diff use sarcoidosis [33]...
    • ...In this renal disease, urinalysis can be either normal or show sterile leukocyturia or mild tubular proteinuria that responds to glucocorticosteroids [33]...

    Hans-Joachim Anderset al. Renal co-morbidity in patients with rheumatic diseases

    • ... Three of 17 (18%) relapsed upon ceasing therapy and responded to reinitiation of corticosteroids, 1 (6%) ceased therapy and was lost to follow-up and represented an end-stage renal failure, and 2 (12%) had multiple relapses and were successfully managed with the addition of mycophenolate mofetil and azathioprine, respectively...

    Kathearine Dahlet al. A 56-year-old woman with sarcoidosis and acute renal failure

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