Granulomatous Sarcoid Disease of the Kidney

Abstract

A case report of a 27 year old white male butcher is presented. He was first admitted to hospital on July 19, 1962, with a 3 week history of anorexia, malaise, fever and enlarge tender lymph nodes in groins, axillae and neck. Skin tests for tuberculosis were nagative, smears and cultures for acid-fast bacilli were negative with sputum, gastric washings, urine and groin lymph nodes. Repeated serum calciums and proteins were normal. Urinalysis consistently revealed microscopic hematuria with scattered granular and red cell casts. Serial tests of renal function are tabulated. Radiographic examinations of chest, hands and feet were normal. An intravenous pyelogram revealed large kidneys. Two groin lymph-node biopsies were compatible with Boeck''s sarcoid. Percutaneous needle biopsy of the left kidney was diagnosed as Boeck''s sarcoid. Treatment with prednisone provided symptomatic improvement and repeat renal biopsies 6 and 21 months later were suggestive, but not conclusive, of amelioration of the disease process. Four earlier reports of renal impairment due to massive sarcoid invasion in the absence of nephrocalcinosis are discussed in relation to the present case.