Sarcoid granulomatous interstitial nephritis accompanied by type 2 diabetes mellitus

Abstract

A 54-year-old type 2 diabetic woman had suffered from clouded vision indicating uveitis. Funduscopic examination showed retinal vein dilatation without diabetic retinopathy. Although urinalysis showed - to ± protein, the serum creatinine elevated. Urinary albumin excretion rate; 29mg/g · creatinine and urine β2-microglobulin; 9600μg/l reflected increased tubular protein excretion. Renal biopsy showed non-caseous granuloma with lymphocytic infiltration in the renal interstitium. It did not show diabetic nephropathy. The chest computed tomograms showed slightly peripheral granular shadow in bilateral lower lung fields. Pulmonary uptake of gallium-67 was positive. We diagnosed sarcoidosis accompanied by diabetes mellitus. The renal dysfunction may be caused by sarcoid granulomatous interstitial nephritis. We began giving her 40mg of methylprednisolone daily for renal involvement due to sarcoidosis. After blood glucose elevation, we then changed from glibenclamide to insulin therapy. The clouded vision subsequently recovered. Serum creatinine and urine β2-microglobulin returned to normal range.