Granulomatous interstitial nephritis causing acute renal failure: a rare presenting feature of sarcoidosis.
A 56-year-old Caucasian woman presented to a peripheral hospital with 8 months history of abdominal discomfort, nausea, night sweats and lethargy. She had lost 10 kg weight and had recovered from an episode of painless bilateral cheek swelling ∼2 months prior to presentation. There was no history of rash, red eyes, dry mouth, joint pains, cough, breathlessness or chest pain. Her only medication at presentation was omeprazole.

On admission, she was dehydrated, and had pain and tenderness in the right hypochondrium of the abdomen. Vital signs and physical examination were otherwise normal. Initial blood tests were as follows: creatinine 266 μmol/l, urea 12.3 mmol/l, albumin 49 g/l, corrected calcium 2.61 mmol/l, C-reactive protein 7 mg/l, erythrocyte sedimentation rate (ESR) 11 mm/h, haemoglobin 15.1 g/dl and white blood cell count 5.4 × 109/l. Liver function tests and urine microscopy examination were normal. Twenty-four hour urine protein excretion was 0.24 g. Chest X-ray was interpreted as normal by the admitting team. Renal tract ultrasound scan showed normal appearance of kidneys and urinary bladder. Despite rehydration therapy, serum creatinine rose to 411 μmol/l and she was transferred to our centre. Anti-nuclear antibodies, anti-neutrophil cytoplasmic antibodies, complement C3 and C4 levels and myeloma screen were normal or negative. A further review of the initial chest X-ray suggested bilateral hilar enlargement, and …