Skip to main content
Top
Published in: Pediatric Nephrology 2/2006

01-02-2006 | Brief Report

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

Authors: Asha Moudgil, Ronald M. Przygodzki, Kanwal K. Kher

Published in: Pediatric Nephrology | Issue 2/2006

Login to get access

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.
Literature
1.
go back to reference 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 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.
go back to reference Milman N, Hoffman AL, Byg KE (1998) Sarcoidosis in children. Epidemiology in Danes, clinical features, diagnosis, treatment and prognosis. Acta Pediatr 87:871–878CrossRef Milman N, Hoffman AL, Byg KE (1998) Sarcoidosis in children. Epidemiology in Danes, clinical features, diagnosis, treatment and prognosis. Acta Pediatr 87:871–878CrossRef
3.
go back to reference McCurely T, Salter J, Glick A (1990) Renal insufficiency in sarcoidosis. A clinical and pathologic study. Arch Pathol Lab Med 114:488–492PubMed McCurely T, Salter J, Glick A (1990) Renal insufficiency in sarcoidosis. A clinical and pathologic study. Arch Pathol Lab Med 114:488–492PubMed
4.
go back to reference Bergner R, Hoffmann M, Waldherr R, Uppenkamp M (2003) Frequency of kidney disease in chronic sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 20:126–132PubMed Bergner R, Hoffmann M, Waldherr R, Uppenkamp M (2003) Frequency of kidney disease in chronic sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 20:126–132PubMed
5.
go back to reference 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 55:297–302PubMed 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 55:297–302PubMed
6.
go back to reference Brause M, Magnusson K, Degenhardt S, Helmchen U, Grabense B (2002) Renal involvement in sarcoidosis—a report of 6 cases. Clin Nephrol 57:142–148PubMed Brause M, Magnusson K, Degenhardt S, Helmchen U, Grabense B (2002) Renal involvement in sarcoidosis—a report of 6 cases. Clin Nephrol 57:142–148PubMed
7.
go back to reference 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 18:280–284CrossRefPubMed 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 18:280–284CrossRefPubMed
8.
go back to reference Hannedouche T, Grateau G, Noel LH, Godin M, Fillastre JP, Grunfeld JP (1990) Renal granulomatous sarcoidosis: report of 6 cases. Nephrol Dial Transplant 5:18–24PubMed Hannedouche T, Grateau G, Noel LH, Godin M, Fillastre JP, Grunfeld JP (1990) Renal granulomatous sarcoidosis: report of 6 cases. Nephrol Dial Transplant 5:18–24PubMed
9.
go back to reference 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 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
10.
go back to reference Sharma OP (1996) Vitamin D, calcium and sarcoidosis. Chest 109:535–553PubMed Sharma OP (1996) Vitamin D, calcium and sarcoidosis. Chest 109:535–553PubMed
12.
go back to reference 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 93:30–36CrossRefPubMed 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 93:30–36CrossRefPubMed
13.
go back to reference 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 158:154–159CrossRefPubMed 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 158:154–159CrossRefPubMed
14.
go back to reference 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 13:377–380PubMed 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 13:377–380PubMed
15.
go back to reference Alan RK (1991) A review of angiotensin converting enzyme in health and disease. Sarcoidosis 8:95–100PubMed Alan RK (1991) A review of angiotensin converting enzyme in health and disease. Sarcoidosis 8:95–100PubMed
16.
go back to reference Bernard J, Newman LS (2001) Sarcoidosis: immunology, rheumatic involvement and therapeutics: Curr Opin Rheumatol 13:84–91 Bernard J, Newman LS (2001) Sarcoidosis: immunology, rheumatic involvement and therapeutics: Curr Opin Rheumatol 13:84–91
17.
18.
go back to reference Pacheo Y, Maraechai C, Marechai F, Biot N, Perrin FM (1985) Azathioprine treatment of chronic pulmonary sarcoidosis. Sarcoidosis 2:107–113PubMed Pacheo Y, Maraechai C, Marechai F, Biot N, Perrin FM (1985) Azathioprine treatment of chronic pulmonary sarcoidosis. Sarcoidosis 2:107–113PubMed
19.
go back to reference Dimitriades C, Shetty KA, Vehaskari VM, Craver RD, Gedalia A (1999) Membranous nephropathy associated with childhood sarcoidosis. Pediatr Nephrol 13:444–447CrossRefPubMed Dimitriades C, Shetty KA, Vehaskari VM, Craver RD, Gedalia A (1999) Membranous nephropathy associated with childhood sarcoidosis. Pediatr Nephrol 13:444–447CrossRefPubMed
20.
go back to reference Yee AM, Pochapin MB (2001) Treatment of complicated sarcoidosis with infliximab anti-tumor necrosis factor-alpha therapy. Ann Intern Med 135:27–31PubMed Yee AM, Pochapin MB (2001) Treatment of complicated sarcoidosis with infliximab anti-tumor necrosis factor-alpha therapy. Ann Intern Med 135:27–31PubMed
21.
go back to reference Dety JD, Mazur JE, Judson MA (2005) Treatment of sarcoidosis with infliximab. Chest 127:1064–1071CrossRefPubMed Dety JD, Mazur JE, Judson MA (2005) Treatment of sarcoidosis with infliximab. Chest 127:1064–1071CrossRefPubMed
22.
go back to reference 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 45:411–414PubMed 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 45:411–414PubMed
23.
go back to reference Morris KP, Coulthard MG, Smith PJ, Craft AW (1996) Renovascular and growth effects of childhood sarcoid. Arch Dis Child 75:74–75PubMed Morris KP, Coulthard MG, Smith PJ, Craft AW (1996) Renovascular and growth effects of childhood sarcoid. Arch Dis Child 75:74–75PubMed
24.
go back to reference 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 61:1029–1037PubMed 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 61:1029–1037PubMed
25.
go back to reference 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 10:1542–1549PubMed 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 10:1542–1549PubMed
26.
go back to reference Choi MJ, Eustacew JA, Gimenez LF, Atta MG, Scheel PJ, Sothinathan R, Briggs WA (2002) Mycophenolate mofetil treatment for primary glomerular diseases. Kidney Int 61:1098–1114CrossRefPubMed Choi MJ, Eustacew JA, Gimenez LF, Atta MG, Scheel PJ, Sothinathan R, Briggs WA (2002) Mycophenolate mofetil treatment for primary glomerular diseases. Kidney Int 61:1098–1114CrossRefPubMed
27.
go back to reference 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 350:971–980CrossRefPubMed 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 350:971–980CrossRefPubMed
28.
go back to reference 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 24:59–67PubMed 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 24:59–67PubMed
29.
go back to reference Kouba DJ, Mimouni D, Rencic A, Nousari HC (2003) Mycophenolate mofetil may serve as a steroid-sparing agent for sarcoidosis. Br J Dermatol 148:147–148CrossRefPubMed Kouba DJ, Mimouni D, Rencic A, Nousari HC (2003) Mycophenolate mofetil may serve as a steroid-sparing agent for sarcoidosis. Br J Dermatol 148:147–148CrossRefPubMed
30.
go back to reference Carmichael P, O’Donnell JP (2003) The protean face of renal sarcoid. J Nephrol 16:7121–7127 Carmichael P, O’Donnell JP (2003) The protean face of renal sarcoid. J Nephrol 16:7121–7127
Metadata
Title
Successful steroid-sparing treatment of renal limited sarcoidosis with mycophenolate mofetil
Authors
Asha Moudgil
Ronald M. Przygodzki
Kanwal K. Kher
Publication date
01-02-2006
Publisher
Springer-Verlag
Published in
Pediatric Nephrology / Issue 2/2006
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-005-2086-3

Other articles of this Issue 2/2006

Pediatric Nephrology 2/2006 Go to the issue