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Background <p>Sarcoidosis-associated hypercalcemia can cause acute kidney injury (AKI); however, reports of severe cases superimposed on advanced chronic kidney disease (CKD) stage G4 requiring hemodialysis (HD) are rare. We report a case that offers important clinical insights into diagnostic pitfalls in patients with CKD and the clinical approach to identify reversible “treatable AKI.”</p> Case presentation <p>A man in his seventies with baseline CKD stage G4 (serum creatinine [Cr] 2.3–2.6&#xa0;mg/dL, estimated glomerular filtration rate [eGFR] 19.0–23.0&#xa0;mL/min/1.73m<sup>2</sup>) due to nephrosclerosis was emergently admitted for moderate hypercalcemia (corrected serum calcium 13.3&#xa0;mg/dL) and AKI (Cr 5.15&#xa0;mg/dL, eGFR 9.3&#xa0;mL/min/1.73m<sup>2</sup>). Endocrinological examination revealed suppressed intact parathyroid hormone (PTH) and elevated 1,25-dihydroxyvitamin D (1,25(OH)<sub>2</sub>D), leading to a diagnosis of PTH-independent, vitamin D-dependent hypercalcemia. Although serum angiotensin-converting enzyme (ACE) levels were within the normal range, this was considered to be masked by the chronic use of an ACE inhibitor (imidapril). A clinical diagnosis of sarcoidosis was made on the basis of markedly elevated soluble IL-2 receptor and lysozyme levels and mediastinal lymphadenopathy. Owing to his poor general condition, tissue biopsy could not be performed. Emergency HD was promptly initiated, followed by corticosteroid therapy with prednisolone (30&#xa0;mg/day) once the clinical diagnosis was strongly suspected. Following treatment, hypercalcemia normalized rapidly, and kidney function gradually improved, allowing liberation from dialysis after five HD sessions.</p> Conclusions <p>When encountering unexplained AKI with hypercalcemia in patients with CKD, clinicians should consider sarcoidosis as a potential underlying cause. Additionally, clinicians will perform a multifaceted evaluation including 1,25(OH)<sub>2</sub>D measurement. Even in severe cases requiring dialysis, early diagnosis and appropriate treatment can render the condition a “treatable AKI.”</p>

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Diagnosis and treatment of sarcoidosis-associated hypercalcemia requiring emergency hemodialysis: a case report

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月24日

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  • Kei Nakada,
  • Motoshi Hattori,
  • Taro Ando,
  • Ryo Nakatani,
  • Madoka Sato,
  • Mizuki Komatsu,
  • Masayuki Okazaki,
  • Hiroshi Kawaguchi

摘要

Background

Sarcoidosis-associated hypercalcemia can cause acute kidney injury (AKI); however, reports of severe cases superimposed on advanced chronic kidney disease (CKD) stage G4 requiring hemodialysis (HD) are rare. We report a case that offers important clinical insights into diagnostic pitfalls in patients with CKD and the clinical approach to identify reversible “treatable AKI.”

Case presentation

A man in his seventies with baseline CKD stage G4 (serum creatinine [Cr] 2.3–2.6 mg/dL, estimated glomerular filtration rate [eGFR] 19.0–23.0 mL/min/1.73m2) due to nephrosclerosis was emergently admitted for moderate hypercalcemia (corrected serum calcium 13.3 mg/dL) and AKI (Cr 5.15 mg/dL, eGFR 9.3 mL/min/1.73m2). Endocrinological examination revealed suppressed intact parathyroid hormone (PTH) and elevated 1,25-dihydroxyvitamin D (1,25(OH)2D), leading to a diagnosis of PTH-independent, vitamin D-dependent hypercalcemia. Although serum angiotensin-converting enzyme (ACE) levels were within the normal range, this was considered to be masked by the chronic use of an ACE inhibitor (imidapril). A clinical diagnosis of sarcoidosis was made on the basis of markedly elevated soluble IL-2 receptor and lysozyme levels and mediastinal lymphadenopathy. Owing to his poor general condition, tissue biopsy could not be performed. Emergency HD was promptly initiated, followed by corticosteroid therapy with prednisolone (30 mg/day) once the clinical diagnosis was strongly suspected. Following treatment, hypercalcemia normalized rapidly, and kidney function gradually improved, allowing liberation from dialysis after five HD sessions.

Conclusions

When encountering unexplained AKI with hypercalcemia in patients with CKD, clinicians should consider sarcoidosis as a potential underlying cause. Additionally, clinicians will perform a multifaceted evaluation including 1,25(OH)2D measurement. Even in severe cases requiring dialysis, early diagnosis and appropriate treatment can render the condition a “treatable AKI.”