Elevated 1,25-dihydroxyvitamin D levels: occurrence with sarcoidosis with end-stage renal disease

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Abstract
The kidneys are considered the only site of 1-hydroxylation of vitamin D and abnormal Ca metabolism in sarcoidosis is believed to be caused by increased production of 1,25-dihydroxyvitamin D (1,25-[OH]2D). A patient with sarcoidosis with hypercalcemic nephropathy and end-stage renal disease undergoing long-term maintenance hemodialysis who was initially seen with hypercalcemia and elevated serum levels of 1,25-(OH)2D is described. Prednisone administration resulted in decreased serum Ca and 1,25-(OH)2D levels. The results confirm recent evidence for extrarenal production of 1,25-(OH)2D in sarcoidosis and illustrate the importance of altered vitamin D metabolism in the development of hypercalcemia in sarcoidosis.