Arthur Kavanaugh, MD


August 03, 2000


Is it possible for a patient to have sarcoidosis without pulmonary involvement? A patient presented with high levels of blood urea nitrogen and creatinine and a high erythrocyte sedimentation rate. We performed renal biopsy, which revealed interstitial nephritis. The patient had no history of drug intake and the angiotensin-converting enzyme (ACE) level was normal. We thought that the patient had sarcoidosis with renal involvement, and we started steroid therapy. Do you think that this patient had sarcoidosis?

Response from Arthur Kavanaugh, MD

Certainly, patients can have sarcoidosis without having pulmonary involvement, although this is the case in less than 10% of sarcoid patients. Because the ACE level largely reflects the activity of pulmonary disease, sarcoid patients without extensive pulmonary involvement can have normal ACE levels. In the case presented, based on the information provided, there does not appear to be enough additional evidence (eg, granulomata or involvement in other organ systems) to convincingly support a diagnosis of sarcoid.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.