A curious case of growth failure and hypercalcemia: Questions

• Published in: Pediatric nephrology (Berlin, West) West), 2018-06, Vol.33 (6), p.991-993
• Main Authors: Downie, Mallory L., Mulder, Jaap, Schneider, Rayfel, Lim, Lillian, Tehrani, Nasrin, Wasserman, Jonathan D., Fuchs, Shai, John, Rohan, Noone, Damien G., Hebert, Diane
• Format: Article
• Language: English
• Subjects: Adolescent; Angiotensin; Biopsy; Blood pressure; Calcinosis; Calcium; Care and treatment; Case reports; Children; Clinical Quiz; Complications and side effects; Creatinine; Diagnosis; Diagnosis, Differential; Dosage and administration; Drug therapy; Etiology; Eye examinations; Failure to Thrive - etiology; Glucocorticoids - therapeutic use; Granulomas; Hemoglobin; Humans; Hypercalcemia; Hypercalcemia - etiology; Hypercalciuria; Kidney - pathology; Kidney diseases; Kidney failure; Male; Medicine; Medicine & Public Health; Nephritis; Nephrology; Pediatric respiratory diseases; Pediatrics; Peptidyl-dipeptidase A; Prednisone; Prednisone - therapeutic use; Renal failure; Renal Insufficiency - etiology; Sarcoidosis; Sarcoidosis - complications; Sarcoidosis - diagnosis; Sarcoidosis - drug therapy; Ultrasound; Urology; Uveitis
• ISSN: 0931-041X; 1432-198X
• DOI: 10.1007/s00467-017-3768-3

Background Sarcoidosis is a multisystem granulomatous disease of unknown etiology that rarely presents in childhood. Here, we report a case of pediatric sarcoidosis presenting with renal failure and hypercalcemia. Case diagnosis/Treatment A previously well 14-year-old Caucasian boy was admitted to the Hospital for Sick Children, Canada, for hypertension and renal failure following work-up by his family physician for initial concerns of growth failure. On admission, his weight was 35 kg (99th percentile for height). Laboratory findings showed elevated creatinine (218 μmol/L), hypercalcemia (3.21 mmol/L), and normocytic anemia (hemoglobin 105 g/L). His further assessment showed a urinary concentrating defect with hypercalciuria (calcium/creatinine 1.76 mmol/mmol) and nephrocalcinosis on ultrasound. His eye examination showed uveitis with conjunctival biopsy remarkable for granulomas, which led to pursuit of a diagnosis of possible sarcoidosis. Angiotensin-converting enzyme was found to be high at 96 U/L, and he had a renal biopsy that was consistent with interstitial nephritis with granulomas. Treatment was started with prednisone leading to resolution of his hypercalcemia but persistence of his mild chronic kidney disease. Conclusions This case represents an atypical presentation of a rare pediatric disease and highlights the spectrum of renal manifestations and treatment options in sarcoidosis.