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Erschienen in: Clinical and Experimental Nephrology 10/2019

25.06.2019 | Original article

Increase of 1,25 dihydroxyvitamin D in sarcoidosis patients with renal dysfunction

verfasst von: Naoya Toriu, Keiichi Sumida, Masahiko Oguro, Yoichi Oshima, Hiroki Mizuno, Eiko Hasegawa, Tatsuya Suwabe, Masahiro Kawada, Toshiharu Ueno, Noriko Hayami, Akinari Sekine, Rikako Hiramatsu, Masayuki Yamanouchi, Junichi Hoshino, Naoki Sawa, Kenmei Takaichi, Kenichi Ohashi, Keiichi Kinowaki, Takeshi Fujii, Ryosuke Date, Yoshifumi Ubara

Erschienen in: Clinical and Experimental Nephrology | Ausgabe 10/2019

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Abstract

Introduction

In sarcoidosis, renal involvement includes hypercalcemia-related nephrocalcinosis and granulomatous tubulointerstitial nephritis. Hypercalcemia is thought to be due to increased production of 1,25 dihydroxyvitamin D (1-25D), but 1-25D levels have not been evaluated in sarcoidosis patients with renal dysfunction.

Materials and Methods

We enrolled 9 sarcoidosis patients who underwent renal biopsy, and compared the serum 1-25D concentration and eGFR with those in 428 non-sarcoidosis patients who had renal dysfunction (stage 2 or higher CKD with an estimated glomerular filtration rate < 90).

Results

Serum calcium and 1-25D levels were significantly higher in the sarcoidosis patients than in the non-sarcoidosis patients (p < 0.01 and p = 0.01, respectively). There was a positive correlation between 1-25D and eGFR in the patients without sarcoidosis (r = 0.693; p < 0.01). As the renal function of sarcoidosis patients was improved by steroid therapy, the serum 1-25D and adjusted serum calcium levels decreased to near the median values in non-sarcoidosis patients. On renal biopsy, CD68 staining was positive for tissue macrophages in all 8 patients who had tubulointerstitial nephritis (with or without typical granulomas), while Von Kossa staining showed calcification of tubules near or inside granulomas in 6 of these 8 patients.

Conclusion

While tissue macrophages promote development of tubulointerstitial nephritis and 1-25D overproduction in renal sarcoidosis, hypercalcemia secondary to elevation of 1-25D may be related to renal calcification and granuloma formation.
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Metadaten
Titel
Increase of 1,25 dihydroxyvitamin D in sarcoidosis patients with renal dysfunction
verfasst von
Naoya Toriu
Keiichi Sumida
Masahiko Oguro
Yoichi Oshima
Hiroki Mizuno
Eiko Hasegawa
Tatsuya Suwabe
Masahiro Kawada
Toshiharu Ueno
Noriko Hayami
Akinari Sekine
Rikako Hiramatsu
Masayuki Yamanouchi
Junichi Hoshino
Naoki Sawa
Kenmei Takaichi
Kenichi Ohashi
Keiichi Kinowaki
Takeshi Fujii
Ryosuke Date
Yoshifumi Ubara
Publikationsdatum
25.06.2019
Verlag
Springer Singapore
Erschienen in
Clinical and Experimental Nephrology / Ausgabe 10/2019
Print ISSN: 1342-1751
Elektronische ISSN: 1437-7799
DOI
https://doi.org/10.1007/s10157-019-01760-3

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