Hypercalcemia and renal insufficiency – where can we start?

Osszefoglalo. Kozlemenyunkben egy 63 eves ferfi esetet ismertetjuk, aki faradekonysag, fogyas miatt vegzett laboratoriumi vizsgalatokon igazolodo veseelegtelenseg es hypercalcaemia miatt kerult felvetelre Klinikankra. A teruleten vegzett rontgenvizsgalaton a koponyan frontalisan es a sacrumon csontelteresek (temporofrontalisan 13 mm-es, korulirtabb, mersekelten intenziv arnyek es az S1-es res sclerosisa) abrazolodtak, ultrahangvizsgalat soran lepmegnagyobbodas volt lathato. Tunetei hattereben endokrin vagy malignus betegseg nem igazolodott. A hatterben elsősorban myeloma multiplex merult fel, ugyanakkor azt celzott vizsgalatokkal sem megerősiteni, sem kizarni nem lehetett, igy csontvelő-biopszia tortent. A vesefunkcio-romlas okanak tisztazasa vegett vesebiopsziat vegeztunk, melynek előzetes eredmenye interstitialis nephritist velemenyezett oriassejtekkel. Az angiotenzinkonvertalo enzim szerumszintjenek ez okbol tortenő vizsgalata emelkedett szintet mutatott, igy esetunket Boeck-sarcoidosis extrapulmonalis manifesztaciojanak tartottuk. Per os szteroidkezelesre a beteg tunetei egyertelmű regressziot mutattak. A csontvelő- es vesebiopszia eredmenye megerősitette a Boeck-sarcoidosis diagnozisat. A sarcoidosis ezen extrapulmonalis formaja hypercalcaemiaval es veseerintettseggel - de tudőerintettseg nelkul - rendkivul ritka, kulonos tekintettel a veset erintő formara. Hypercalcaemia nagyjabol 7,9%-ban, veseelegtelenseg 1,4%-ban fordul elő. Ezen eset alapjan fontos hangsulyozni, hogy a hypercalcaemia es a veseelegtelenseg hattereben a gyakoribb endokrin, malignus, hematologiai okok mellett a Boeck-sarcoidosisnak is fel kell merulnie a differencialdiagnosztika soran. Orv Hetil. 2021; 162(13): 514-518. Summary. We present the case of a 63-year-old male patient who was admitted to our Clinic with fatigue, weight loss, hypercalcemia, renal insufficiency and anemia. X-ray showed lesions on the frontal skull and sacral region. On abdominal ultrasound, splenomegaly was detected. Based on these, myeloma multiplex was the most likely initial diagnosis; this, however, could not be confirmed with targeted serum tests, therefore bone marrow biopsy was performed. To clarify the underlying cause of decreased kidney function, renal biopsy was performed, the preliminary results of which revealed interstitial nephritis accompanied by giant cells. Serum angiotensin converting enzyme level was elevated, which led to the diagnosis of Boeck sarcoidosis with extrapulmonary manifestations. Oral corticosteroid therapy was commenced that was followed by regression of the patient's symptoms and laboratory abnormalities. Both the bone marrow and the kidney biopsies supported the diagnosis of Boeck sarcoidosis. Presentation of sarcoidosis with hypercalcemia and renal insufficiency but without the involvement of the lungs is extremely rare. Hypercalcemia occurs in about 7.9% and renal insufficiency in 1.4% of the cases. Based on this case, it is important to highlight that in the background of hypercalcemia and renal failure - beside the more frequent causes such as endocrine and hematological diseases, malignancy - one is to consider the possibility of Boeck sarcoidosis as well. Orv Hetil. 2021; 162(13): 514-518.