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Review
. 2023 Apr 15;24(8):7327.
doi: 10.3390/ijms24087327.

The Overlap of Kidney Failure in Extrapulmonary Sarcoidosis in Children-Case Report and Review of Literature

Adriana Mocanu  1   2 , Roxana Alexandra Bogos  1   2 , Laura Mihaela Trandafir  1 , Elena Cojocaru  1 , Ileana Ioniuc  1 , Mirabela Alecsa  1 , Vasile Valeriu Lupu  1 , Lucian Miron  1 , Tudor Ilie Lazaruc  1 , Ancuta Lupu  1 , Ingrith Crenguta Miron  1 , Iuliana Magdalena Starcea  1   2
Affiliations
Review

The Overlap of Kidney Failure in Extrapulmonary Sarcoidosis in Children-Case Report and Review of Literature

Adriana Mocanu et al. Int J Mol Sci. .

Abstract

Sarcoidosis is a non-necrotizing granulomatous inflammatory multisystemic disorder of unknown etiology. In children, as in adults, it can involve a few or all organ systems to a varying extent and degree, entailing multisystemic manifestations. Kidney involvement in pediatric-onset adult-type sarcoidosis is rare, with a wide range of renal manifestations, most of them related to calcium metabolism. Children with renal sarcoidosis tend to be more symptomatic than adults, although male patients have a higher prevalence. We present the case of a 10-year-old boy who presented with advanced renal failure with nephrocalcinosis and important hepatosplenomegaly. The diagnosis was established by histopathological examination, with consequent cortisone therapy and hemodialysis. This review emphasizes that sarcoidosis should be considered in the differential diagnosis of pediatric patients with acute kidney insufficiency or chronic kidney disease of an unknown etiology. As far as we know, this is the first study regarding extrapulmonary sarcoidosis in children from Romania.

Keywords: children; chronic kidney disease; extrapulmonary sarcoidosis; nephrocalcinosis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Differential diagnosis at presentation.
Figure 2
Figure 2
Differential diagnosis at presentation.
Figure 3
Figure 3
Axial CT scans, bilateral medullary nephrocalcinosis (blue arrow).
Figure 4
Figure 4
Axial CT scans, portal hypertension (blue arrow).
Figure 5
Figure 5
(a): PAS coloration ×100; (b): PAS coloration ×200. Liver tissue showing chronic giant cell granulomatous hepatitis (blue arrows) (personal collection, St. Mary Emergency Children’s Hospital, Iasi).
Figure 6
Figure 6
(a) Szekely trichrome staining ×100, (b) Szekely trichrome staining ×200. Liver biopsy: tight, well-formed epithelioid granuloma of sarcoidosis, not directed at the bile duct. There is a cuff of lymphocytes (black arrows) and Langhans giant cell, with the nuclei arranged in a ring along the periphery (blue arrow). Even not specific, Langhans type giant cells are characteristic of sarcoidosis (personal collection, St. Mary Emergency Children’s Hospital, Iasi).
Figure 7
Figure 7
Hematoxylin-eosin staining ×200; renal tissue showing interstitial inflammation (yellow arrow) (personal collection, St. Mary Emergency Children’s Hospital, Iasi).
Figure 8
Figure 8
Hematoxylin-eosin staining ×200; renal tissue showing calcifications (blue arrows) (personal collection, St. Mary Emergency Children’s Hospital, Iasi).
Figure 9
Figure 9
Szekely trichrome staining ×100; renal tissue showing interstitial fibrosis (yellow arrow) (personal collection, St. Mary Emergency Children’s Hospital, Iasi).
Figure 10
Figure 10
Characteristics of our patient at presentation, 1, 2 and 3 months after therapy initiation.
See this image and copyright information in PMC

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