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

Author:

Klaus Richard,Jansson Annette Friederike,Griese Matthias,Seeman Tomas,Amann Kerstin,Lange-Sperandio Bärbel

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.

Funder

Deutsche Forschungsgemeinschaft

Publisher

Frontiers Media SA

Subject

Pediatrics, Perinatology and Child Health

Cited by 6 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Imaging Features of Pediatric Sarcoidosis;RadioGraphics;2024-01-01

2. The Overlap of Kidney Failure in Extrapulmonary Sarcoidosis in Children—Case Report and Review of Literature;International Journal of Molecular Sciences;2023-04-15

3. A case of childhood renal sarcoidosis;Japanese journal of pediatric nephrology;2023

4. Uncommon Causes of Acute Kidney Injury;Critical Care Clinics;2022-04

5. Un caz de sarcoidoză extrapulmonară ce mimează boala metastatică;Oncolog-Hematolog.ro;2022

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