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Successful steroid-sparing treatment of renal limited sarcoidosis with mycophenolate mofetil

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Abstract

Sarcoidosis is a multi-system disorder characterized by non-caseating epithelioid granulomas in multiple organs. The disease usually presents in young adults and is uncommon in children. Renal involvement can usually occur due to granulomatous interstitial nephritis, but renal failure is uncommon. Corticosteroids are the mainstay of therapy. We present the report of a child with severe renal failure secondary to renal limited sarcoidosis who was successfully treated with corticosteroid induction therapy. Because of the severe side effects of corticosteroids, mycophenolate mofetil was added and corticosteroids were tapered off. The child has been in sustained remission for over a year with mycophenolate mofetil monotherapy.

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References

  1. Katz S (1994) Clinical presentation and natural history of sarcoidosis. In: Fanburg BL (ed) Sarcoidosis and other granulomatous diseases of the lung. Marcel Dekkar, New York, pp 247–266

  2. Milman N, Hoffman AL, Byg KE (1998) Sarcoidosis in children. Epidemiology in Danes, clinical features, diagnosis, treatment and prognosis. Acta Pediatr 87:871–878

    Article  Google Scholar 

  3. McCurely T, Salter J, Glick A (1990) Renal insufficiency in sarcoidosis. A clinical and pathologic study. Arch Pathol Lab Med 114:488–492

    PubMed  Google Scholar 

  4. Bergner R, Hoffmann M, Waldherr R, Uppenkamp M (2003) Frequency of kidney disease in chronic sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 20:126–132

    PubMed  Google Scholar 

  5. O’Riordan E, Willert RP, Reeve R, Kalra PA, O’Donoghue DJ, Foley RN, Waldek S (2001) Isolated sarcoid granulomatous interstitial nephritis: review of five cases at one center. Clin Nephrol 55:297–302

    PubMed  Google Scholar 

  6. Brause M, Magnusson K, Degenhardt S, Helmchen U, Grabense B (2002) Renal involvement in sarcoidosis—a report of 6 cases. Clin Nephrol 57:142–148

    PubMed  Google Scholar 

  7. Robson MG, Banerjee D, Hopster D, Cairns HS (2003) Seven cases of granulomatous interstitial nephritis in the absence of extra renal sarcoid. Nephrol Dial Transplant 18:280–284

    Article  PubMed  Google Scholar 

  8. Hannedouche T, Grateau G, Noel LH, Godin M, Fillastre JP, Grunfeld JP (1990) Renal granulomatous sarcoidosis: report of 6 cases. Nephrol Dial Transplant 5:18–24

    PubMed  Google Scholar 

  9. Baughman RP, Lower EE (1998) Treatment of sarcoidosis with corticosteroids: who is going to relapse and why? Sarcoidosis Vasc Diffuse Lung Dis 1:19–20

    Google Scholar 

  10. Sharma OP (1996) Vitamin D, calcium and sarcoidosis. Chest 109:535–553

    PubMed  Google Scholar 

  11. United States Renal Data System database (2005) http://www.USRDS.org

  12. Byg KE, Milman N, Hansen S (2004) Childhood sarcoidosis in Denmark 1979–1994: incidence, clinical features and laboratory results at presentation in 48 children. Acta Paediatr 93:30–36

    Article  PubMed  Google Scholar 

  13. Coutant R, Leroy B, Niaudet P, Loirat C, Dommergues JP, Andre JL, Baculard A, Bensman A (1999) Renal granulomatous sarcoidosis in childhood: a report of 11 cases and review of the literature. Eur J Pediatr 158:154–159

    Article  PubMed  Google Scholar 

  14. Sessa A, Meroni M, Battini, G, Vigano G, Brambilla PL, Paties CT (2000) Acute renal failure due to idiopathic tubulo-intestinal nephritis and uveitis: “TINU syndrome”. Case report and review of the literature. J Nephrol 13:377–380

    PubMed  Google Scholar 

  15. Alan RK (1991) A review of angiotensin converting enzyme in health and disease. Sarcoidosis 8:95–100

    PubMed  Google Scholar 

  16. Bernard J, Newman LS (2001) Sarcoidosis: immunology, rheumatic involvement and therapeutics: Curr Opin Rheumatol 13:84–91

    Google Scholar 

  17. Du Bois RM (1994) Corticosteroids in sarcoidosis: friend or foe? Eur Respir J 7:1203–1209

    Article  PubMed  Google Scholar 

  18. Pacheo Y, Maraechai C, Marechai F, Biot N, Perrin FM (1985) Azathioprine treatment of chronic pulmonary sarcoidosis. Sarcoidosis 2:107–113

    PubMed  Google Scholar 

  19. Dimitriades C, Shetty KA, Vehaskari VM, Craver RD, Gedalia A (1999) Membranous nephropathy associated with childhood sarcoidosis. Pediatr Nephrol 13:444–447

    Article  PubMed  Google Scholar 

  20. Yee AM, Pochapin MB (2001) Treatment of complicated sarcoidosis with infliximab anti-tumor necrosis factor-alpha therapy. Ann Intern Med 135:27–31

    PubMed  Google Scholar 

  21. Dety JD, Mazur JE, Judson MA (2005) Treatment of sarcoidosis with infliximab. Chest 127:1064–1071

    Article  PubMed  Google Scholar 

  22. Thumfart J, Muller D, Rudolph B, Zimmering M, Querfeld U, Haffner D (2005). Isolated sarcoid granulomatous interstitial nephritis responding to infliximab therapy. Am J Kidney Dis 45:411–414

    PubMed  Google Scholar 

  23. Morris KP, Coulthard MG, Smith PJ, Craft AW (1996) Renovascular and growth effects of childhood sarcoid. Arch Dis Child 75:74–75

    PubMed  Google Scholar 

  24. The Tricontinental Mycophenolate Mofetil Renal Transplantation Study Group (1996) A blinded, randomized clinical trial of mycophenolate mofetil for the prevention of acute rejection in cadaveric renal transplantation. Transplantation 61:1029–1037

    PubMed  Google Scholar 

  25. Remuzzi G, Zoja C, Gagliardini E, Coma D, Abbate M, Benigni A (1999) Combining an antiproteinuric approach with mycophenolate mofetil fully suppresses progressive nephropathy of experimental animals. J Am Soc Nephrol 10:1542–1549

    PubMed  Google Scholar 

  26. Choi MJ, Eustacew JA, Gimenez LF, Atta MG, Scheel PJ, Sothinathan R, Briggs WA (2002) Mycophenolate mofetil treatment for primary glomerular diseases. Kidney Int 61:1098–1114

    Article  PubMed  Google Scholar 

  27. Contreras G, Parado V, Leclereg B, Lenz O, Tozman E, O’Nan P, Roth D (2004) Sequential therapies for proliferative lupus nephritis. N Engl J Med 350:971–980

    Article  PubMed  Google Scholar 

  28. Laurent AF, Dumont S, Poindron P, Muller CD (1996) Mycophenolic acid suppresses protein N-linked glycosylation in human monocytes and their adhesion to endothelial cells and some substrates. Exp Hematol 24:59–67

    PubMed  Google Scholar 

  29. Kouba DJ, Mimouni D, Rencic A, Nousari HC (2003) Mycophenolate mofetil may serve as a steroid-sparing agent for sarcoidosis. Br J Dermatol 148:147–148

    Article  PubMed  Google Scholar 

  30. Carmichael P, O’Donnell JP (2003) The protean face of renal sarcoid. J Nephrol 16:7121–7127

    Google Scholar 

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Authors and Affiliations

  1. Division of Nephrology, 1.5-100 West Wing, Children’s National Medical Center, 111 Michigan Avenue NW, Washington, DC, 20010, USA

    Asha Moudgil & Kanwal K. Kher

  2. Division of Pathology, Children’s National Medical Center, Washington, DC, USA

    Ronald M. Przygodzki

Authors
  1. Asha Moudgil
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  2. Ronald M. Przygodzki
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  3. Kanwal K. Kher
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Correspondence to Asha Moudgil.

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Moudgil, A., Przygodzki, R.M. & Kher, K.K. Successful steroid-sparing treatment of renal limited sarcoidosis with mycophenolate mofetil. Pediatr Nephrol 21, 281–285 (2006). https://doi.org/10.1007/s00467-005-2086-3

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  • DOI: https://doi.org/10.1007/s00467-005-2086-3

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