Q: My mother-in-law is 72 years old. She has been diagnosed with sarcoidosis of kidneys. She has some patches on her skin and her raised calcium levels were always blamed on her kidney function. We visited India recently. She had raised temperature in the morning and evening for a month, due to which she was admitted to the hospital. Doctors were suspecting tuberculosis (TB) and kept her in isolation. After various tests, she was finally treated with steroids. Can sarcoidosis be treated? Can it attack the system again? She has ileostomy due to ulcerative colitis, high blood pressure and diabetes and now sarcoidosis. Her kidney functions are about 20% and blood sugar is high due to the steriods. What precautions should we take?

A:You have not stated how was your mother-in-law diagnosed with sarcoidosis of kidneys. I am assuming that kidney biopsy was done to establish the diagnosis. Nevertheless, sarcoidosis responds nicely to steroids. Sarcoidosis is a disease that may affect any organ or system of the body. Sarcoidosis may have no symptoms at all. Only small changes might show up on a chest x-ray, or one may have progressive failure of many organs in the body. The cause of sarcoidosis is not known. It most commonly affects adults between 20 and 40 years of age, but it may occur at any age. It is important to note that not all patients with sarcoidosis require treatment and that a decision to treat is generally symptom-based. Kidneys may be involved by this disease in a variety of ways that include increased calcium levels, obstruction of enlarged nodes, interstitial nephritis and rarely various types on glomerulonephritis. In most cases it responds well to a course of steroids but relapses or flares of sarcoidosis are not infrequent and in some individuals they may get worse with time. However, another concern is side effects of steroids like increased blood sugar and blood pressure etc. Methotrexate has been tried as steroid sparing regimen with limited success and other agents like thalidomide have been tried as well. In your mother additional precautions directed at better BP and blood sugar control and normalising calcium levels will help preserving her limited renal function as well.