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Author Topic: Renal Sarocoidosis
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Post Renal Sarocoidosis
on: February 20, 2013, 15:19
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I have a patient who is presumed to have renal sarcoidosis. He has a signficantly elevated 1,25 di-hydroxy vitamin D level. He was empirically started on prednisone but that led to a catastrophic GI bleed requiring 7 units of prbc transfusions.

We plan on a kidney biopsy of this patient in the very near future. If our diagnosis is correct, do you recommend an alternative therapy to treat renal sarcoidosis?

Nephrology Fellow

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Post Re: Renal Sarocoidosis
on: February 20, 2013, 15:29
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Great question. There are a few options you have at your disposal other than steroids. Keep in mind the data is limited in steroid-sparing treatment for renal sarcoidosis, but given your patient's contraindication to prednisone, these options may be reasonable.

1. MMF -- a case report in a child showed improvement in renal function when treated with MMF, starting at 1000 mg bid and tapered down slowly: http://download.springer.com/static/pdf/673/art%253A10.1007%252Fs00467-005-2086-3.pdf?auth66=1362687646_1ebaaaf05e03e2f8b9241c2020ece3d3&ext=.pdf

2. Infliximab at 3 mg/kg/q-month -- again this is from a case report and the patient was maintained on prednisone 10 mg daily as well as the infliximab. http://download.springer.com/static/pdf/673/art%253A10.1007%252Fs00467-005-2086-3.pdf?auth66=1362687646_1ebaaaf05e03e2f8b9241c2020ece3d3&ext=.pdf

3. Either methotrexate or azathioprine or other immunosuppressive agent -- this is a great review of the different therapies one can try if unresponsive to prednisone -- see table 2 http://www.sciencedirect.com/science/article/pii/S0272523108000312#

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