Case Report: Pediatric Renal Sarcoidosis and Prognostic Factors in Reviewed Cases

Klaus, Richard; Jansson, Annette Friederike; Griese, Matthias; Seeman, Tomas; Amann, Kerstin and Lange-Sperandio, Bärbel (13. September 2021): Case Report: Pediatric Renal Sarcoidosis and Prognostic Factors in Reviewed Cases. In: Frontiers in Pediatrics, Vol. 9, 724728

Abstract

Background: Pediatric sarcoidosis is a complex inflammatory disorder with multisystemic manifestations. Kidney involvement in children is rare, and prognostic factors are unknown.

Case Report and Methods: We report the case of a 16-year-old girl with multiorgan sarcoidosis and renal involvement. The patient presented with tubulointerstitial nephritis, acute kidney injury (AKI), chest CT disseminated noduli, granulomatous iridocyclitis, giant-cell sialadenitis, and arthralgia. The kidney biopsy revealed non-granulomatous interstitial nephritis. Treatment consisted of initial high-dose methylprednisolone pulse followed by oral prednisolone and methotrexate. Full remission was achieved. In addition, we performed a literature review using PubMed and analyzed data on pediatric renal sarcoidosis cases.

Results: We identified 36 cases of pediatric sarcoidosis with renal involvement on presentation and data on the end-of-follow-up glomerular filtration rate (GFR). The data from the literature review showed that renal involvement was slightly more prevalent in males (60%). AKI was present in most of the described patients (84%). Oral prednisolone was used in 35 of 36 cases; in more severe cases, other immunosuppressants were used. We newly identified renal concentration impairment and granulomatous interstitial nephritis as factors with a clear trend toward GFR loss at the end of follow-up, emphasizing the importance of kidney biopsy in symptomatic patients. In contrast, higher GFR at presentation and hypercalcemia were rather favorable factors. According to the identified predictive factors, our patient has a good prognosis and is in remission.

Conclusion: The factors indicating a trend toward an unfavorable renal outcome in pediatric sarcoidosis are renal concentration impairment and granulomatous interstitial nephritis at presentation, while a higher GFR is beneficial.

• Item Type: Journal article
• Keywords: Sarcoidosis; tubulointerstitial nephritis; acute kidney injury; case report; prognostic factor analysis
• Faculties: Medicine
• Subjects: 600 Technology > 610 Medicine and health
• ISSN: 2296-2360
• Language: English