Abstract
Background
Sarcoidosis is a multisystem granulomatous disease of unknown etiology that rarely presents in childhood. Here, we report a case of pediatric sarcoidosis presenting with renal failure and hypercalcemia.
Case diagnosis/Treatment
A previously well 14-year-old Caucasian boy was admitted to the Hospital for Sick Children, Canada, for hypertension and renal failure following work-up by his family physician for initial concerns of growth failure. On admission, his weight was 35 kg (<3rd percentile), his height was 148 cm (≪3rd percentile), and his blood pressure was 154/116 mmHg (>99th percentile for height). Laboratory findings showed elevated creatinine (218 μmol/L), hypercalcemia (3.21 mmol/L), and normocytic anemia (hemoglobin 105 g/L). His further assessment showed a urinary concentrating defect with hypercalciuria (calcium/creatinine 1.76 mmol/mmol) and nephrocalcinosis on ultrasound. His eye examination showed uveitis with conjunctival biopsy remarkable for granulomas, which led to pursuit of a diagnosis of possible sarcoidosis. Angiotensin-converting enzyme was found to be high at 96 U/L, and he had a renal biopsy that was consistent with interstitial nephritis with granulomas. Treatment was started with prednisone leading to resolution of his hypercalcemia but persistence of his mild chronic kidney disease.
Conclusions
This case represents an atypical presentation of a rare pediatric disease and highlights the spectrum of renal manifestations and treatment options in sarcoidosis.
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Contributions
M. L. Downie provided interpretation of results, drafted the manuscript, and approved of the manuscript as written.
J. Mulder contributed to diagnostic workup, provided interpretation of results, drafted the manuscript, and approved of the manuscript as written.
R. Schneider contributed to diagnostic workup, provided interpretation of results, critically revised the manuscript, and approved of the manuscript as written.
N. Tehrani contributed to diagnostic workup, provided interpretation of results, critically revised the manuscript, and approved of the manuscript as written.
J. Wasserman contributed to diagnostic workup, provided interpretation of results, critically revised the manuscript, and approved of the manuscript as written.
R. John contributed to diagnostic workup, provided interpretation of results, critically revised the manuscript, and approved of the manuscript as written.
D. Noone critically revised the manuscript and approved of the manuscript as written.
D. Hebert contributed to diagnostic workup, provided interpretation of results, critically revised the manuscript, and approved of the manuscript as written.
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The answers to these questions can be found at http://dx.doi.org/10.1007/s00467-017-3769-2.
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Downie, M.L., Mulder, J., Schneider, R. et al. A curious case of growth failure and hypercalcemia: Questions. Pediatr Nephrol 33, 991–993 (2018). https://doi.org/10.1007/s00467-017-3768-3
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DOI: https://doi.org/10.1007/s00467-017-3768-3