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<p>Sarcoidosis is a systemic granulomatous disease of unknown etiology, characterized by non-caseating epithelioid granulomas in multiple organs. Renal involvement is uncommon and often under-recognized, particularly when biopsy is avoided due to renal atrophy or bleeding risk. As a result, the true prevalence of renal sarcoidosis remains uncertain and may be underestimated. In Japan, a notable proportion of patients undergoing dialysis or kidney transplantation are classified as having chronic kidney disease (CKD) of unknown etiology, highlighting the ongoing challenge of establishing a definitive diagnosis in advanced CKD. We report a case of renal-limited sarcoidosis diagnosed during pre-transplant evaluation in a patient initially labeled as having CKD of unknown etiology. This case illustrates how renewed imaging assessment can uncover treatable pathology, including mass-forming renal sarcoidosis, even in presumed “burned-out” kidneys.</p>

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Renal sarcoidosis misdiagnosed as a “burned-out” kidney: diagnosis achieved during pre-transplant evaluation

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月25日

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  • Toru Matsugasumi,
  • Kosuke Ogawa,
  • Kazutoshi Okubo,
  • Hitomi Miyata

摘要

Sarcoidosis is a systemic granulomatous disease of unknown etiology, characterized by non-caseating epithelioid granulomas in multiple organs. Renal involvement is uncommon and often under-recognized, particularly when biopsy is avoided due to renal atrophy or bleeding risk. As a result, the true prevalence of renal sarcoidosis remains uncertain and may be underestimated. In Japan, a notable proportion of patients undergoing dialysis or kidney transplantation are classified as having chronic kidney disease (CKD) of unknown etiology, highlighting the ongoing challenge of establishing a definitive diagnosis in advanced CKD. We report a case of renal-limited sarcoidosis diagnosed during pre-transplant evaluation in a patient initially labeled as having CKD of unknown etiology. This case illustrates how renewed imaging assessment can uncover treatable pathology, including mass-forming renal sarcoidosis, even in presumed “burned-out” kidneys.