Renal manifestations of sarcoidosis: from accurate diagnosis to specific treatment

ABSTRACT Sarcoidosis is a multisystem granulomatous disease characterized by epithelioid noncaseating granulomas associated with clinical and radiologic findings. The cause of this disease is still uncertain. Sarcoidosis affects mostly lungs and lymph nodes and is not usually considered a urological disease, therefore, this etiology may be overlooked in several urological disorders, such as hypercalcemia, hypercalciuria and nephrolithiasis. It affects all races and genders. This review aims to describe the urological manifestations of sarcoidosis and to elucidate how the disease may affect the management of numerous urological conditions.

Disfunción tubular renal distal en pacientes pediátricos con diagnóstico de desnutrición grave / Dystal renal tubular dysfunction in seriously undernourished pediatric patients

La acidosis metabólica es mas frecuente en los pacientes desnutridos graves que en los eutróficos. El objetivo del presente estudio fue evaluar la función tubular renal en 30 niños desnutridos graves hospitalizados. La investigación fue de tipo prospectiva, descriptiva de corte transversal, se realizó prueba de sobrecarga con bicarbonato de sodio al 5 por ciento a 30 desnutridos graves: marasmo, kwashiorkor o mixtos, con edades de 6 meses a 5 años, etiología primaria, de ambos sexos, hemodinámicamente estables, con acidosis metabólica, hipercloremia y anión gap urinario positivo. Se determinó la relación calcio/creatinina e índice ácido úrico/creatinina. Se calcularon las frecuencias absolutas, relativas, valores medios y desviación estándar. Los lactantes representaron 80 por ciento de los pacientes. Prevalecieron las formas clínicas kwashiorkor y mixtas de evolución crónica. En 12 (40,0 por ciento) pacientes se observó acidosis tubular renal distal. El valor promedio de la relación calcio/creatinina en menores de 2 años de edad fue de 0,362 ± 0,414 y en los mayores de 2 años de 0,265 ± 0,22. El valor promedio del índice ácido úrico/creatinina fue de 0,57 ± 0,28. La acidosis metabólica presente en los pacientes, de acuerdo a los resultados observados, obedece a una disfunción tubular renal distal. La interpretación de la relación calcio/creatinina e índice ácido úrico/creatinina urinaria resulta difícil, haciéndose necesario aumentar las investigaciones en estos pacientes.

Seriously undernourished patients have a bigger tendency to metabolic acidosis than euthrophic individuals. The objective of the present work was to realize a study of the renal tubular function in 30 severely undernourished children. The investigation was a prospective, descriptive and transversal study. A test of overload with 5 percent sodium bicarbonate was realized to 30 seriously undernourished children whose primari etiology was marasmus, kwashiorkor or with mixed conditions, with ages of 6 months to 5 years, from both sexes, hemodynamically stable, with metabolic acidosis, hiperchloremia and positive urinary anion gap. The relation calcium/creatinine and the index uric acid/creatinine were determined. The absolute and relatives frequencies, average values and standard deviations were calculated. Infants represented 80 percent of the evaluated patients. The clinical forms kwashiorkor and mixed forms, of chronic evolution prevailed. Distal tubular renal acidosis was observed in 12 patients (40 percent) after the test overload with 5 percent bicarbonate. The average values of the relation calcium/creatinine of children < 2 years was 0.362 ± 0.414 and of children > 2 years was 0.265 ± 0.222. The uric acid/creatinine index was 0.57 ± 0.28. Metabolic acidosis is frequent in serious infantile undernourishment, which, according to the results observed, obeys to distal renal tubular dysfunction. The interpretation of the relation calcium/creatinine and the uric acid/creatinine index is difficult, becoming necessary to increase the investigations in these patients.