Introduction: Sarcoidosis is a multisystem granulomatous disorder. It commonly causes mild hypercalcemia in up to 1020% of the cases and renal involvement can be a feature. Presentation with severe symptomatic hypercalcaemia (>3.5 mmol/l) and acute kidney injury is rare. We present an interesting case.
Case: A 58 year old female was referred to the emergency department by her general practitioner with a one month history of polyuria, generalised weakness and fatigue. She had a background of multisystem sarcoidosis with ophthalmic, pulmonary and lymphoreticular involvement diagnosed two years previously by tissue biopsy. Her sarcoidosis was in remission, with regular follow-up in respiratory clinic. She was off steroids for two years prior to admission. Her clinical examination was unremarkable.
Investigation and management: The laboratory results revealed an estimated glomerular filtration rate (eGFR) of 26 ml/min from a baseline of 67 ml/min a few months prior, high adjusted calcium (3.95 mmol/l), low vitamin D 25-OH (39 nmol/l, adequate >50 nmol/l), normal parathormone levels and a raised angiotensin converting enzyme of 109 U/l, all indicating active sarcoidosis. A diagnosis of severe hypercalcaemia and acute kidney injury secondary to an exacerbation of sarcoidosis was made. Renal ultrasound showed no evidence of stones or hydronephrosis; myeloma and immunology screening tests were negative. The patient responded to intravenous fluid resuscitation and 40 mg oral prednisolone, her calcium and renal function normalised and she was discharged with a reducing dose of prednisolone. Two months post-discharge serum calcium and eGFR remained normal on 5 mg prednisolone daily.
Discussion: We report a rare acute presentation of sarcoidosis, namely severe symptomatic hypercalcaemia and acute kidney injury. Early intervention in this case has prevented the long term sequelae of acute renal failure due to sarcoid related hypercalcemia.