Case: 38 year old female presented to ER with severe pain going from "loin to groin". Patient has established diagnosis of Sarcoidosis?


Answer: Nephrolithiasis in sarcoidosis may be caused by hypercalcemia and hypercalciuria secondary to increase in 1,25-dihydroxyvitamin D and calcitriol production by activated macrophages. Hypercalcemia is generally treated with intravenous hydration. If EKG changes noted than systemic steroids are indicated. Ketoconazole is said to decrease 1,25-dihydroxyvitamin D and is helpful in minimizing hypercalcemia and hypercalciuria.