Renal involvement in sarcoidosis: histological patterns and prognosis, an Italian survey. Renal involvement in sarcoidosis.

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Francesco Rastelli
Ivano Baragetti
Laura Buzzi
Francesca Ferrario
Luisa Benozzi
Francesco Di Nardo
Elisabetta Devoti
Giovanni Cancarini
Nicoletta Mezzina
Pietro Napodano
Maurizio Gallieni
Domenico Santoro
Michele Buemi
Paola Pecchini
Fabio Malberti
Valeriana Colombo
Giacomo Colussi
Ettore Sabadini
Giuseppe Remuzzi
Lucia Argentiero
Loreto Gesualdo
Guido Gatti
Francesco Trevisani
Giorgio Slaviero
Donatella Spotti
Olga Baraldi
Gaetano La Manna
Eugenia Pignone
Marco Saltarelli
Marco Heidempergher
Michela Tedesco
Augusto Genderini
Michela Ferro
Cristiana Rollino
Dario Roccatello
Gabriella Guzzo
Roberta Clari
Giorgina Piccoli
Cristina Comotti
Giuliano Brunori
Paolo Cameli
Elena Bargagli
Paola Rottoli
Mauro Dugo
Maria Cristina Maresca
Massimo Bertoli
Morena Giozzet
Rachele Brugnano
Emidio Giovanni Nunzi
Marco D'Amico
Claudio Minoretti
Irene Acquistapace
Carla Colturi
Ernesto Minola
Mario Camozzi
Antonella Tosoni
Manuela Nebuloni
Franco Ferrario
Giacomo Dell'Antonio
Stefano Cusinato
Sandro Feriozzi
Claudio Pozzi

Keywords

Abstract

Background: Granulomatous interstitial nephritis in sarcoidosis (sGIN) is generally clinically silent, but in <1% causes acute kidney injury (AKI). Methods: This Italian multicentric retrospective study included 39 sarcoidosis-patients with renal involvement at renal biopsy: 31 sGIN-AKI, 5 with other patterns (No-sGIN-AKI), 3 with nephrotic proteinuria. We investigate the predictive value of clinical features, laboratory, radiological parameters and histological patterns regarding steroid response. Primary endpoint: incident chronic kidney disease (CKD) beyond the 1°follow-up (FU) year; secondary endpoint: response at 1°line steroid therapy; combined endpoint: the association of initial steroid response and outcome at the end of FU. Results: Complete recovery in all 5 No-sGIN-AKI-patients, only in 45% (13/29) sGIN-AKI-patients (p=0.046) (one lost in follow-up, for another not available renal function after steroids). Nobody had not response. Primary endpoint of 22 sGIN-AKI subjects: 65% (13/20) starting with normal renal function developed CKD (2/22 had basal CKD; median FU 77 months, 15–300). Combined endpoint: 29% (6/21) had complete recovery and final normal renal function (one with renal relapse), 48% (10/21) had partial recovery and final CKD (3 with renal relapse, of whom one with basal CKD) (p=0.024). Acute onset and hypercalcaemia were associated to milder AKI and better recovery than subacute onset and patients without hypercalcaemia, women had better endpoints than men. Giant cells, severe interstitial infiltrate and interstitial fibrosis seemed negative predictors in terms of endpoints. Conclusions: sGIN-AKI-patients with no complete recovery at 1°line steroid should be treated with other immunosuppressive to avoid CKD, in particular if males with subacute onset and III stage-not hypercalcaemic AKI.

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