Rapidly Progressive Renal Failure: A Rare Clinical Presentation of Renal Sarcoidosis

A 54 -year-old woman presented with history of easy fatiguability for last 3 months, breathlessness for last 2 months and feverish feelings for last 2 weeks. Initial laboratory findings of a raised serum creatinine & BUN which was increased by 1mg/dl in more than 2 weeks indicative of RPRF (Rapidly progressive renal faliure). Along with other investigations including raised serum calcium, raised serum protein (9.5 g/l) and normal serum albumin (4.3 g/l), lead to an initial working diagnosis of multiple myeloma as a cause of RPRF. However, later serum protein electrophoresis found a polyclonal gammopathy and further investigations lead us to think about granulomatous disorders, and ultimately we reach the diagnosis of systemic sarcoidosis. The patient responded well to steroids. Sarcoidosis is a rare cause of RPRF & polyclonal gammopathy is a less well recognised manifestation of sarcoidosis, its presence should make clinicians to think about the diagnosis of sarcoidosis.