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 degrees follow-up (FU) year; secondary endpoint: response at 1 degrees 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 degrees line steroid should be treated with other immunosuppressive to avoid CKD, in particular if males with subacute onset and III stage-not hypercalcaemic AKI.

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

Ferrario, Francesca;La Manna, Gaetano;Roccatello, Dario;Guzzo, Gabriella;Clari, Roberta;Barbara Piccoli, Giorgina;
2021-01-01

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 degrees follow-up (FU) year; secondary endpoint: response at 1 degrees 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 degrees line steroid should be treated with other immunosuppressive to avoid CKD, in particular if males with subacute onset and III stage-not hypercalcaemic AKI.
2021
38
3
e2021017
e2021017
AKI; Acute onset; GenPhenReSa phenotypes; Giant cells; Hypercalcaemia; Interstitial fibrosis; Interstitial infiltrate; Renal sarcoidosis; Steroids; Subacute onset; sACE; sGIN
Rastelli, Francesco; Baragetti, Ivano; Buzzi, Laura; Ferrario, Francesca; Benozzi, Luisa; Di Nardo, Francesco; Devoti, Elisabetta; Cancarini, Giovanni...espandi
File in questo prodotto:
File Dimensione Formato  
SVDLD-38-17.pdf

Accesso aperto

Tipo di file: PDF EDITORIALE
Dimensione 2.52 MB
Formato Adobe PDF
2.52 MB Adobe PDF Visualizza/Apri

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2318/1822111
Citazioni
  • ???jsp.display-item.citation.pmc??? 1
  • Scopus 9
  • ???jsp.display-item.citation.isi??? 5
social impact