Barıs ESER, Özlem YAYAR, Huseyin Yüce BİRCAN, Zafer ERCAN, Mehmet BÜYÜKBAKKAL, M Deniz AYLİ

Sarkoidozlu Bir Hastada Böbrek Taşı, Hiperkalsemi ve Böbrek Yetmezliği

Hiperkalsemi sarkoidozun nadiren ilk başvuru semptomu olan bir bulgusudur. Burada hiperkalsemi ve böbrek yetmezliği ile başvuran bir olgudan bahsedeceğiz.Hasta hastaneye yan ağrısı nedeniyle başvurdu. Ultrasonografide medüller nefrokalsinoz tespit edildi. Hiperkalsemi ve böbrek yetmezliği saptanan hastanın PTH düzeyi baskılanmış olarak bulundu. Bilgisayarlı tomografide mediastinal adenopati tespit edildi ve serum ACE düzeyi yüksek olarak bulundu. Böbrek biyopsisinde oksalat kristalleri ile tıkanmış tubuller görüldü. Transbronşial lenf nodu biyopsisi tanısal gelmedi. Sarkoidoz düşünülen hastaya kortikosteroid tedavisi başlandı ve kreatinin düzeyi 3 mg/dl de stabilize oldu. Paratiroid bağımlı olmayan hiperkalsemide sarkoidoz düşünülmelidir. Tanının erken konulması nefrokalsinozis ve böbrek yetmezliği gelişimini engelleyebilir.

Sarcoidosis In a Patient with nephrolithiasis, hypercalcemia and renal failure

Hypercalcemia is a known but rare complication of sarcoidosis. We report a case of sarcoidosis presenting with hypercalcemia and renal failure Twenty two years old woman admitted to hospital with recurrent loin pain. Abdominal ultrasonography showed medullary nephrocalcinosis . Labarotory analysis revealed persistent hypercalcemia and renal insufficiency. PTH level was suppressed. Bilateral lymphadenopathy seen in Chest x-ray, reported as mediastinal adenopathy in CT scan. Serum ACE level was elevated. Renal biopsy revealed tubular obstruction with oxalate crystals. Trans-bronchial lymph node biopsy was non-diagnostic. Corticosteroid treatment was started with suspicion of sarcoidosis and creatinine level decreased gradually to 3 mg/dl. Sarcoidosis without pulmonary symptoms should be suspected in patients with non-parathyroid associated hypercalcemia. Early diagnosis and appropriate treatment may prevent development of nephrocalcinosis and renal failure.

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