Recurrence of sarcoidosis in renal allograft during pregnancy

1Department of Nephrology and 2Department of Pathology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic Sarcoidosis is a multisystem disorder of unknown aetiology characterized by the accumulation of lymphocytes, mononuclear phagocytes, and non-caseating granulomas in involved tissues. Renal involvement leading to renal function deterioration in sarcoidosis is rare: it is observed in <10% of patients. In the relevant literature, there have been only a few cases of sarcoidosis recurrence in renal allograft recipients published. We present here the first case of sarcoidosis recurrence in renal allograft during pregnancy. A 27-year-old woman was diagnosed with sarcoidosis at age 14 by lacrimal and parotid gland biopsy. Initial therapy did not include steroids as no pulmonary or other organ involvement was documented. However, hypertension and renal insufficiency (serum creatinine [sCr] 300 µmol/l) were present 4 years later. Renal biopsy revealed sarcoid interstitial granulomatous nephritis with granulomatous arteritis. The patient was treated with steroids for 3 years, at which time re-biopsy revealed no granulomas but interstitial nephritis and nephrosclerosis. During the next 3 years renal function progressively deteriorated and haemodialysis was initiated. At age 22, the patient underwent cadaveric kidney transplantation with excellent kidney graft function (sCr 70–90 µmol/l, creatinine clearance [CCr] 1.32 ml/s) and negative urinalysis. Immunosuppression consisted of triple therapy based on cyclosporine A (CsA; target trough levels 200–300 ng/ml for the first month and 150–250 ng/ml for the rest of the first year), azathioprine (100 mg/day) and steroids (prednisone 25 mg/day).