TULBURARIALESTARIIDECONSTIENTA,HIPERCALCEMIESIINSUFICIENTARENALAACUTALA UNPACIENTDE71ANI

Autor:AnaMariaPetcu1 Coautor:RolandaHanke1,RoxanaStoica2,MarilenaStoian3,VictorStoica4

1 2

Student,anulVI,UniversitateadeMedicinasiFarmacieCarolDavilaBucuresti MedicRezidentClinicaMedicala,SpitalClinicDr.I.Cantacuzino 3 Asist.Univ.ClinicaMedicala,SpitalClinicDr.I.Cantacuzino 4 Prof.Univ.ClinicaMedicala,SpitalClinicDr.I.Cantacuzino

Abstract Introduction: Sarcoidosis (from sarc meaning flesh, oid, like, and osis, diseased or abnormal condition), is a disease in which abnormal collections of chronic inflammatory cells (granulomas) form as nodules in multiple organs. The cause of sarcoidosis is unknown. Granulomas most often appear in the lungs or the lymph nodes, but virtually any organ can be affected. Materials and methods: we present the case of a 71 years old patient, monitored by the urologist doctor for prostate adenoma, who was admitted in the hospital with nausea, weight loss (10 kg in 4 months) and short period memory loss. The clinical and paraclinical status (hypercalcemia associated with high level of parathyroid hormone, serum albumin, CT, galium scintigraphy, renal biopsy) guided us to sarcoidosis. Results: after the treatment with Prednisone 40mg\day the calcium level normalized in6weeksandtheserum albuminin12weeks.Conclusions: Sarcoidosisgranulomascan affectany organ.Itisnecessaryaprecociousdiagnosisandtreatmenttostopthediseasesevolution. Keywords:sarcoidosis,granulomas

CAZCLINIC Barbat,71deani Monitorizatdemediculurologpentruadenomdeprostata Seinterneazapentru: greata scadereponderala(10kgin4luni) tulburarialememorieidescurtadurata EXAMENOBIECTIV Pacientsubponderal Turgorcutanatscazut Mucoasepalide CV:TA160/100mmHg,AV60/min Fara alte modificari patologice, exceptand o prostata neregulata, marita de volum PARACLINIC INVESTIGATIIBIOCHIMICE Hb10,4g/dl,normocroma,normocitara Na142mmol/l K4,5mmol/l Uree95mg/dl Creatininaserica2,8mg/dl Calciuseric11mg/dl EVALUAREARENALA Ecografieabdominala:rinichidedimensiuni,formasiecogenitatenormale Sumardeurinapestick:eritrocite2+;proteine+,glucoza+ Sedimenturinar:relativfrecventicilindrigranulosi Imagineecogaficanormala BIOPSIARENALA Granuloameepitelioide(sageatarosie)siinfiltratinterstitialzonal(sageata galbena), cu celule gigante, inflamatie si atrofie tubulara moderata si fibroza interstitiala:

NEFRITAIN NTERSTITIALA AGRANULOM MATOASA DISCUTII

Sarcoidoza S ar a trebuie luata in co onsiderare ca diagnostic la orice e pacient cu hipercalcemie esiinsuficie entarenalaacuta. a
CTTORACIC Numerosinodulidemic cidimensiuni iparahilardre eaptasistang ga Ganglioniparatrahealisi s subcarinalicudiametrul laxial<1cm m

SC CINTIGRAFIECUGALIU Captarea cresc cuta a radiotr rasorului in regiunile hilar re bilaterale, cu captare su uplimentara in arotidesimin nimacaptarelanivelulrini ichilor pa

 DIAGNOSTICDIFERENTIAL Cauzedehipercalcemie: - mielommultiplu, - hiperparatiroidism, - metastazeleosoase, - hipercalcemiatumoraladinneoplazii, - sarcoidoza, - boalaAdison, - unelemedicamente Cauzedenefritainterstitialagranulomatoasa: - medicamente, - TBC, - sarcoidoza, - oxalatii. Certitudinea diagnostica a impus efectuarea biopsiei renale care a exclus alte cauze de hipercalcemie cum ar fi mielomul multiplu, metastazele unor carcinoame secundare si hiperparatiroidismul.

EVOLUTIACLINICA TratamentcuPrednison40mg/zi,6luni: Ameliorareastatusuluimental Normalizareaniveluluicalcemieidupadoar6saptamanidetratament Normalizareacreatinineisericedupa12saptamani DIAGNOSTICULPOZITIV CTtorace Scintigrafiacugaliu Biopsierenala NivelnormalalPTH SARCOIDOZA

CONCLUZII

Desi sarcoidoza este boala multisistemica, exista situatii in care insuficienta renala este singura
manifestare clinica a afectiunii Acest tip de sarcoidoza este responsiv la corticoterapie, iar diagnosticul siterapiaprecocesuntesentialeinstopareadeteriorariirenale.