Pediatric Nephrology

, Volume 21, Issue 2, pp 281–285 | Cite as

Successful steroid-sparing treatment of renal limited sarcoidosis with mycophenolate mofetil

  • Asha Moudgil
  • Ronald M. Przygodzki
  • Kanwal K. Kher
Brief Report

Abstract

Sarcoidosis is a multi-system disorder characterized by non-caseating epithelioid granulomas in multiple organs. The disease usually presents in young adults and is uncommon in children. Renal involvement can usually occur due to granulomatous interstitial nephritis, but renal failure is uncommon. Corticosteroids are the mainstay of therapy. We present the report of a child with severe renal failure secondary to renal limited sarcoidosis who was successfully treated with corticosteroid induction therapy. Because of the severe side effects of corticosteroids, mycophenolate mofetil was added and corticosteroids were tapered off. The child has been in sustained remission for over a year with mycophenolate mofetil monotherapy.

Keywords

Sarcoidosis Renal failure Interstitial nephritis Mycophenolate mofetil Granulomas 

References

  1. 1.
    Katz S (1994) Clinical presentation and natural history of sarcoidosis. In: Fanburg BL (ed) Sarcoidosis and other granulomatous diseases of the lung. Marcel Dekkar, New York, pp 247–266Google Scholar
  2. 2.
    Milman N, Hoffman AL, Byg KE (1998) Sarcoidosis in children. Epidemiology in Danes, clinical features, diagnosis, treatment and prognosis. Acta Pediatr 87:871–878CrossRefGoogle Scholar
  3. 3.
    McCurely T, Salter J, Glick A (1990) Renal insufficiency in sarcoidosis. A clinical and pathologic study. Arch Pathol Lab Med 114:488–492PubMedGoogle Scholar
  4. 4.
    Bergner R, Hoffmann M, Waldherr R, Uppenkamp M (2003) Frequency of kidney disease in chronic sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 20:126–132PubMedGoogle Scholar
  5. 5.
    O’Riordan E, Willert RP, Reeve R, Kalra PA, O’Donoghue DJ, Foley RN, Waldek S (2001) Isolated sarcoid granulomatous interstitial nephritis: review of five cases at one center. Clin Nephrol 55:297–302PubMedGoogle Scholar
  6. 6.
    Brause M, Magnusson K, Degenhardt S, Helmchen U, Grabense B (2002) Renal involvement in sarcoidosis—a report of 6 cases. Clin Nephrol 57:142–148PubMedGoogle Scholar
  7. 7.
    Robson MG, Banerjee D, Hopster D, Cairns HS (2003) Seven cases of granulomatous interstitial nephritis in the absence of extra renal sarcoid. Nephrol Dial Transplant 18:280–284CrossRefPubMedGoogle Scholar
  8. 8.
    Hannedouche T, Grateau G, Noel LH, Godin M, Fillastre JP, Grunfeld JP (1990) Renal granulomatous sarcoidosis: report of 6 cases. Nephrol Dial Transplant 5:18–24PubMedGoogle Scholar
  9. 9.
    Baughman RP, Lower EE (1998) Treatment of sarcoidosis with corticosteroids: who is going to relapse and why? Sarcoidosis Vasc Diffuse Lung Dis 1:19–20Google Scholar
  10. 10.
    Sharma OP (1996) Vitamin D, calcium and sarcoidosis. Chest 109:535–553PubMedGoogle Scholar
  11. 11.
    United States Renal Data System database (2005) http://www.USRDS.org
  12. 12.
    Byg KE, Milman N, Hansen S (2004) Childhood sarcoidosis in Denmark 1979–1994: incidence, clinical features and laboratory results at presentation in 48 children. Acta Paediatr 93:30–36CrossRefPubMedGoogle Scholar
  13. 13.
    Coutant R, Leroy B, Niaudet P, Loirat C, Dommergues JP, Andre JL, Baculard A, Bensman A (1999) Renal granulomatous sarcoidosis in childhood: a report of 11 cases and review of the literature. Eur J Pediatr 158:154–159CrossRefPubMedGoogle Scholar
  14. 14.
    Sessa A, Meroni M, Battini, G, Vigano G, Brambilla PL, Paties CT (2000) Acute renal failure due to idiopathic tubulo-intestinal nephritis and uveitis: “TINU syndrome”. Case report and review of the literature. J Nephrol 13:377–380PubMedGoogle Scholar
  15. 15.
    Alan RK (1991) A review of angiotensin converting enzyme in health and disease. Sarcoidosis 8:95–100PubMedGoogle Scholar
  16. 16.
    Bernard J, Newman LS (2001) Sarcoidosis: immunology, rheumatic involvement and therapeutics: Curr Opin Rheumatol 13:84–91Google Scholar
  17. 17.
    Du Bois RM (1994) Corticosteroids in sarcoidosis: friend or foe? Eur Respir J 7:1203–1209CrossRefPubMedGoogle Scholar
  18. 18.
    Pacheo Y, Maraechai C, Marechai F, Biot N, Perrin FM (1985) Azathioprine treatment of chronic pulmonary sarcoidosis. Sarcoidosis 2:107–113PubMedGoogle Scholar
  19. 19.
    Dimitriades C, Shetty KA, Vehaskari VM, Craver RD, Gedalia A (1999) Membranous nephropathy associated with childhood sarcoidosis. Pediatr Nephrol 13:444–447CrossRefPubMedGoogle Scholar
  20. 20.
    Yee AM, Pochapin MB (2001) Treatment of complicated sarcoidosis with infliximab anti-tumor necrosis factor-alpha therapy. Ann Intern Med 135:27–31PubMedGoogle Scholar
  21. 21.
    Dety JD, Mazur JE, Judson MA (2005) Treatment of sarcoidosis with infliximab. Chest 127:1064–1071CrossRefPubMedGoogle Scholar
  22. 22.
    Thumfart J, Muller D, Rudolph B, Zimmering M, Querfeld U, Haffner D (2005). Isolated sarcoid granulomatous interstitial nephritis responding to infliximab therapy. Am J Kidney Dis 45:411–414PubMedGoogle Scholar
  23. 23.
    Morris KP, Coulthard MG, Smith PJ, Craft AW (1996) Renovascular and growth effects of childhood sarcoid. Arch Dis Child 75:74–75PubMedGoogle Scholar
  24. 24.
    The Tricontinental Mycophenolate Mofetil Renal Transplantation Study Group (1996) A blinded, randomized clinical trial of mycophenolate mofetil for the prevention of acute rejection in cadaveric renal transplantation. Transplantation 61:1029–1037PubMedGoogle Scholar
  25. 25.
    Remuzzi G, Zoja C, Gagliardini E, Coma D, Abbate M, Benigni A (1999) Combining an antiproteinuric approach with mycophenolate mofetil fully suppresses progressive nephropathy of experimental animals. J Am Soc Nephrol 10:1542–1549PubMedGoogle Scholar
  26. 26.
    Choi MJ, Eustacew JA, Gimenez LF, Atta MG, Scheel PJ, Sothinathan R, Briggs WA (2002) Mycophenolate mofetil treatment for primary glomerular diseases. Kidney Int 61:1098–1114CrossRefPubMedGoogle Scholar
  27. 27.
    Contreras G, Parado V, Leclereg B, Lenz O, Tozman E, O’Nan P, Roth D (2004) Sequential therapies for proliferative lupus nephritis. N Engl J Med 350:971–980CrossRefPubMedGoogle Scholar
  28. 28.
    Laurent AF, Dumont S, Poindron P, Muller CD (1996) Mycophenolic acid suppresses protein N-linked glycosylation in human monocytes and their adhesion to endothelial cells and some substrates. Exp Hematol 24:59–67PubMedGoogle Scholar
  29. 29.
    Kouba DJ, Mimouni D, Rencic A, Nousari HC (2003) Mycophenolate mofetil may serve as a steroid-sparing agent for sarcoidosis. Br J Dermatol 148:147–148CrossRefPubMedGoogle Scholar
  30. 30.
    Carmichael P, O’Donnell JP (2003) The protean face of renal sarcoid. J Nephrol 16:7121–7127Google Scholar

Copyright information

© IPNA 2005

Authors and Affiliations

  • Asha Moudgil
    • 1
  • Ronald M. Przygodzki
    • 2
  • Kanwal K. Kher
    • 1
  1. 1.Division of Nephrology, 1.5-100 West WingChildren’s National Medical CenterWashingtonUSA
  2. 2.Division of PathologyChildren’s National Medical CenterWashingtonUSA

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