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Published in: Pediatric Nephrology 6/2018

01-06-2018 | Clinical Quiz

A curious case of growth failure and hypercalcemia: Questions

Authors: Mallory L. Downie, Jaap Mulder, Rayfel Schneider, Lillian Lim, Nasrin Tehrani, Jonathan D. Wasserman, Shai Fuchs, Rohan John, Damien G. Noone, Diane Hebert

Published in: Pediatric Nephrology | Issue 6/2018

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Abstract

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 (<3rd percentile), his height was 148 cm (≪3rd percentile), and his blood pressure was 154/116 mmHg (>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.
Metadata
Title
A curious case of growth failure and hypercalcemia: Questions
Authors
Mallory L. Downie
Jaap Mulder
Rayfel Schneider
Lillian Lim
Nasrin Tehrani
Jonathan D. Wasserman
Shai Fuchs
Rohan John
Damien G. Noone
Diane Hebert
Publication date
01-06-2018
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Nephrology / Issue 6/2018
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-017-3768-3

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