Published online Jul 6, 2015. doi: 10.5527/wjn.v4.i3.438
Peer-review started: November 13, 2014
First decision: December 26, 2014
Revised: January 14, 2015
Accepted: April 28, 2015
Article in press: April 30, 2015
Published online: July 6, 2015
We report a case of a diabetic patient with progressive chronic kidney disease and unexplained hypercalcemia. This unusual presentation and the investigation of all possible causes led us to perform a renal biopsy. The systemic sarcoidosis diagnosis was confirmed by the presence of interstitial multiple granulomas composed of epithelioid and multinucleated giant cells delimited by a thin fibrous reaction, and by pulmonary computed tomography finding of numerous lumps with ground-glass appearance. Sarcoidosis most commonly involves lungs, lymph nodes, skin and eyes, whilst kidney is less frequently involved. When it affects males it is characterized by hypercalcemia, hypercalciuria, and progressive loss of renal function. Early treatment with steroids allows for a gradual improvement in renal function and normalization of calcium serum values. Otherwise, the patient would quickly progress to end stage renal disease. Finding of hypercalcemia in a patient with renal failure must alert physicians because it may be a sign of several pathological entities.
Core tip: This report not only describes a case of kidney sarcoidosis, but also explains the diagnostic algorithm that led to the correct diagnosis of a case wrongly labelled as chronic kidney disease (CKD) secondary to diabetic nephropathy. The absence of other microangiopathic alterations such as retinopathy and secondly the presence of hypercalcemia with hypoparathyroidism in a patient with CKD need to be further explored.