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- Title
A curious case of growth failure and hypercalcemia: Answers.
- Authors
Downie, Mallory L.; Mulder, Jaap; Schneider, Rayfel; Lim, Lillian; Tehrani, Nasrin; Wasserman, Jonathan D.; Fuchs, Shai; John, Rohan; Noone, Damien G.; Hebert, Diane
- Abstract
Background: Sarcoidosis is a multisystem granulomatous disease of unknown etiology that rarely presents in childhood. Here, we report a case of pediatric sarcoidosis, presenting with renal failure and hypercalcemia.Case diagnosis/Treatment: A previously well 14-year-old Caucasian boy was admitted to the Hospital for Sick Children, Canada, for hypertension and renal failure following work-up by his family physician for initial concerns of growth failure. On admission, his weight was 35 kg (<3rd percentile), his height was 148 cm (<<3rd percentile), and his blood pressure was 154/116 mmHg (>99th percentile for height). Laboratory findings showed elevated creatinine (218 umol/L), hypercalcemia (3.21 mmol/L), and normocytic anemia (hemoglobin 105 g/L). His further assessment showed a urinary concentrating defect with hypercalciuria (calcium/creatinine 1.76 mmol/mmol) and nephrocalcinosis on ultrasound. His eye examination showed uveitis with conjunctival biopsy remarkable for granulomas, which led to pursuit of a diagnosis of possible sarcoidosis. Angiotensin Angiotensin-converting enzyme was found to be high at 96 U/L, and he had a renal biopsy that was consistent with interstitial nephritis with granulomas. Treatment was started with prednisone leading to resolution of his hypercalcemia but persistence of his mild chronic kidney disease.Conclusions: This case represents an atypical presentation of a rare pediatric disease and highlights the spectrum of renal manifestations and treatment options in sarcoidosis.
- Subjects
GRANULOMA; ANEMIA diagnosis; SARCOIDOSIS diagnosis; SARCOIDOSIS treatment; UVEITIS; HYPERCALCIUREA; INTERSTITIAL nephritis; ANGIOTENSIN converting enzyme; BIOPSY; CREATININE; EYE examination; HUMAN growth; HYPERCALCEMIA; HYPERTENSION; KIDNEY calcification; SARCOIDOSIS; DISEASE complications; KIDNEY failure; DIAGNOSIS; THERAPEUTICS
- Publication
Pediatric Nephrology, 2018, Vol 33, Issue 6, p995
- ISSN
0931-041X
- Publication type
Test/Instrument
- DOI
10.1007/s00467-017-3769-2