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August 1972

Nonhypercalcemic Sarcoid Nephropathy

Author Affiliations

Richmond, Va; New York; Richmond, Va

From the departments of medicine and pathology, Medical College of Virginia; Health Sciences Division, Virginia Commonwealth University; and the McGuire Veterans Administration Hospital, Richmond, Va; and the Department of Pathology, Columbia University College of Physicians and Surgeons, and the Lennox Hill Hospital, New York.

Arch Intern Med. 1972;130(2):285-291. doi:10.1001/archinte.1972.03650020103019

Renal insufficiency in sarcoidosis is usually associated with hypercalcemia and hypercalciuria.1-4 These abnormalities of calcium metabolism most frequently result from enhanced gastrointestinal absorption of calcium induced by an increased sensitivity to vitamin D,5 but occasionally occur because of hyperparathyroidism secondary to a parathyroid adenoma.6 The elevated levels of serum and urine calcium ultimately produce renal failure by means of nephrocalcinosis or nephrolithiasis or both with their various sequelae. The occurrence of overt clinical renal disease in sarcoidosis without associated hypercalcemia or hypercalciuria is extremely rare despite the relative frequency of granulomatous renal involvement at necropsy2,4,7 or biopsy material.2,8 Cases of symptomatic nonhypercalcemic sarcoid nephropathy4,7,9-15 have been reported, however. Most have shown a histologic picture of pronounced interstitial inflammation and formation of granulomas,4,9-15 but several cases of membranous glomerulonephritis have been associated with sarcoidosis.16-19

This report describes a patient without hypercalcemia or nephrocalcinosis

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