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Review Article | DOI: https://doi.org/10.31579/2692-9562/140
Educational Supervisor Certificate Rcp London And Accreditation Medical Examiner Member Rc Path London
*Corresponding Author: Anthony Kodzo-Grey Venyo. Educational Supervisor Certificate Rcp London And Accreditation Medical Examiner Member Rc Path London
Citation: Anthony Kodzo-Grey Venyo, (2025), Sarcoidosis of the urogenital tract, Journal of Clinical Otorhinolaryngology, 7(2); DOI:10.31579/2692-9562/140
Copyright: © 2025 Anthony Kodzo-Grey Venyo. This is an open-access article distributed under the terms of The Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Received: 04 March 2025 | Accepted: 10 March 2025 | Published: 15 March 2025
Keywords: Sarcoidosis of the kidney; renal sarcoidosis; acute kidney injury; renal biopsy; histopathology; steroids; immunosuppressants; Rare.
Sarcoidosis is a terminology that is used for systemic inflammatory disease of unknown aetiology. The pathogenesis of sarcoidosis is iterated to rest upon an aberrant T cell response to unidentified antigens in individuals, who are predisposed by genetic and environmental factors. It has been iterated that the increased expression of polarized macrophages and disequilibrium between effector and regulator T cells do contribute to the formation of non-caseating granulomas, which are frequently found within the afflicted organs. The main kidney abnormalities in sarcoidosis are iterated to be granulomatous interstitial nephritis (GIN) and hypercalcemia-related disorders. It has been pointed out that the clinical diagnosis of sarcoidosis has tended to be difficult. The outcome of sarcoidosis has been iterated to be variable, ranging from spontaneous remission to end-stage kidney disease (ESKD). It has been pointed out that early diagnosis of sarcoidosis and prompt treatment with corticosteroids could improve the prognosis sarcoidosis. The diagnosis of sarcoidosis of the kidney is usually confirmed based upon the histopathology examination features of most biopsy specimens which demonstrate non-caseating granulomas in the biopsy specimens. It has been pointed out that in cases of sarcoidosis of the kidney, hypercalcemia may be responsible for the development of acute kidney injury (AKI) which is caused by vasoconstriction of afferent arterioles. Some of the complications of persistent hypercalcemia in cases of sarcoidosis of the kidney had been iterated to include nephrocalcinosis and renal stones. It has been iterated that in patients with ESKD, dialysis and renal-transplantation could offer results that are comparable to those that are observed in patients with other causes of kidney failure.
Sarcoidosis is a chronic granulomatous inflammatory disorder which afflicts various systems of the body. Amongst the organs that tend to be damaged by this inflammatory disorder, the lungs are the most commonly affected. Kidneys even though they tend to be protected from sarcoidosis, it has been iterated that the kidney can be damaged by sarcoidosis in very rare cases. [1] It has been stated that sarcoidosis of the kidney is not very often seen in routine clinical practice. [1] It has been pointed out that the manifestation of sarcoidosis of the kidney could be vague and could vary according to the underlying pathological mechanism and that the diagnosis of sarcoidosis considering its rarity could be very challenging at times. [1] Considering that sarcoidosis of the kidney is not that common, it would be envisaged that the majority of clinicians in the world would tend not to be familiar with the diagnostic features and management of sarcoidosis of the kidney. The ensuing update on sarcoidosis of the kidney is divided into two parts: (A) Overview, and (B) Miscellaneous narrations and discussions from some case reports, case series, and studies related to sarcoidosis of the kidney.
To provide an update on sarcoidosis of the kidney.
Internet databases were searched including: Google, google scholar; yahoo; and PUBMED. The search words that were used included: Sarcoidosis of the kidney; and renal sarcoidosis. Forty-six (46) references were identified which were used to write the chapter which has been divided into two parts: (A) Overview, and (B) Miscellaneous narrations and discussions from some case reports, case series, and studies related to sarcoidosis of the kidney.
[a] overview
Definition / general statement [2]
Essential features
The essential features of sarcoidosis of the kidney had been summated as follows: [2]
Terminology
Epidemiology
The epidemiology of sarcoidosis of the kidney has been summated as follows: [2]
Sites
The sites most commonly afflicted by sarcoidosis had been summated as follows: [2]
Pathophysiology
The pathophysiology of sarcoidosis has been summated as follows: [2]
Aetiology
Clinical features
The clinical features of sarcoidosis had been summated as follows: [2]
Diagnosis
The diagnosis of sarcoidosis has been summated as follows: [2]
Laboratory
Summations which had been made regarding laboratory tests that tend to be undertaken or which should be undertaken in sarcoidosis include the ensuing: [2]
Radiology description
The radiology-imaging in cases of sarcoidosis of the kidney had been summated as follows: [2]
Prognostic factors
Factors of prognostication associated with sarcoidosis of the kidney had been summated as follows: [2]
Treatment
The treatment of sarcoidosis of the kidney had been summated as follows: [2]
Microscopic (histologic) description
The pathology microscopy examination features of sarcoidosis of the kidney had been summated as follows: [2]
Immunofluorescence description
Positive stains
Negative stains
Electron microscopy description
Genetics
Differential diagnoses
The differential diagnoses of sarcoidosis of the kidney had been summated to include the ensuing: [2]
[B] Miscellaneous Narrations and Discussions from Some Case Reports, Case Series, And Studies Related To Sarcoidosis Of The Kidney
Klaus et al. [21] stated that paediatric sarcoidosis is a complex inflammatory disorder with multisystemic presentations, and that sarcoidosis kidney involvement in children is not common as well as that the prognostic factors are not known. Klaus et al. [21] reported the case of a 16-year-old girl who had multi-organ sarcoidosis and kidney involvement. Klaus et al. [21] reported that the patient manifested with tubulointerstitial nephritis, acute kidney injury (AKI), chest CT disseminated noduli, granulomatous iridocyclitis, giant-cell sialadenitis, and arthralgia. She underwent biopsy of her kidney lesion, and pathology examination of the kidney biopsy specimen demonstrated non-granulomatous interstitial nephritis. Her treatment consisted of initial high-dose methylprednisolone pulse, which was ensued by oral prednisolone and methotrexate. Full remission was achieved. In addition, Klaus et al. [21] undertook a literature review using PubMed and they analysed data on paediatric renal sarcoidosis cases. Klaus et al. [21] summated the results as follows:
Klaus et al. [21] concluded that the factors indicating a trend toward an unfavourable renal outcome in paediatric sarcoidosis include: renal concentration impairment and granulomatous interstitial nephritis at presentation, while a higher GFR is beneficial.
De la Hoz et al. [22] made the ensuing iterations:
De la Hoz et al. [22] reported a 20-year-old African-American male, who presented to the emergency department with vague symptoms including fatigue, malaise, anorexia, right-sided lower back pain, and nausea. Acute kidney injury was clearly evident, in that his serum creatinine was 19.78 mg/dL (normal range 0.60-1.20 mg/dL), and BUN was 124.0 mg/dL (normal range 5.0-25.0 mg/dL). His laboratory test results were also remarkable for leukopenia, microcytic anaemia, hyperkalaemia, anion gap metabolic acidosis, and non-PTH dependent hypercalcemia. Interestingly, his urinalysis was equivocal and both his chest x-ray (CXR) and computed tomography (CT) scan of his abdomen and pelvis did not demonstrate any abnormality. He was admitted to the hospital and required renal replacement therapy in order to stabilize his clinical condition while planning for a renal biopsy that was subsequently undertaken. While awaiting pathological results, he developed pancytopenia, and a bone marrow biopsy was then undertaken. On further investigation, his angiotensin-converting enzyme (ACE) turned out to be significantly raised, which had suggested sarcoidosis. He had biopsy of his renal lesion and pathology examination of the kidney biopsy specimen demonstrated moderate acute tubular injury, tubulitis, extensive interstitial oedema, and infiltration by many non-caseating granulomas, which had confirmed the diagnosis of sarcoidosis. Histopathology examination of his bone marrow specimen demonstrated hypocellularity but no granulomatous infiltration. The patient remained largely asymptomatic throughout his hospital stay, with no signs or symptoms suggesting the involvement of other organs. High-dose corticosteroids were commenced and this was continued on outpatient basis after his discharge back home while still on haemodialysis. His pancytopenia resolved while on glucocorticoids and improvement in his renal function was such that after roughly two months of steroids medication, renal replacement therapy was no longer necessary. De la Hoz et al. [22] made the ensuing discussions and conclusions:
Zia et al. [1] made the ensuing iterations:
Zia et al. [1] reported a case of a young 30-year-old male who was referred to the hospital by his primary medical doctor due to right eye pain secondary to iritis and acute kidney injury (AKI). His initial laboratory test results had demonstrated anaemia, AKI, mild hypercalcemia, and the urinary analysis revealed proteinuria. He underwent radiology-imaging studies, which were negative and a kidney biopsy was undertaken and pathology examination of the kidney biopsy specimens showed diffuse tubulointerstitial disease with early fibrosis, widespread moderate inflammation, multifocal tubulitis, and focal aggregate of epithelioid cells suggestive of granuloma consistent with sarcoidosis. The patient was treated with prednisone. Zia et al. [1] made the ensuing discussions:
RØMER [23] reported forty-two patients with sarcoidosis, who were studied with special attention to renal disease and disturbance of calcium metabolism. RØMER [23] reported the results as follows:
RØMER [23] concluded that from the reported case series and review of the literature it did appear that young males within the first two years of diagnosis are at the greatest risk of hypercalcaemia or kidney disease.
Menezes et al. [24] stated that sarcoidosis is a multisystemic granulomatous disease with rare renal involvement. Menezes et al. [24] reported a case of a 45-year-old female patient who was admitted to the hospital with severe acute kidney injury and uveitis. After clinical investigation, sarcoidosis with renal, hepatic and ocular involvement was diagnosed. Pathology examination of her kidney biopsy showed acute granulomatous interstitial nephritis and treatment with systemic corticosteroids was commenced with marked improvement in her renal function.
Casella et al. [25] made the ensuing iterations:
Casella et al. [25] reported the case of a young patient with sarcoidosis who presented with hypercalcemia and acute renal failure. Despite normalization of the serum calcium with intravenous fluids and corticosteroids, his renal insufficiency persisted. A diagnostic renal biopsy was undertaken to determine the aetiology of his renal failure and was helpful in the selection of optimal medical therapy.
Calatroni et al. [26] made the ensuing iterations:
Bergner et al. [27] made the ensuing iterations:
Vender et al. [28] made the ensuing iterations:
Bonella et al. [29] made the ensuing iterations:
Bergner et al. [30] made the ensuing iterations:
Bergner et al. [30] investigated the renal involvement in patients who have sarcoidosis. Bergner et al. [30] summarised the results as follows:
Bergner et al. [30] made the ensuing conclusions:
Bagnasco et al. [31] made the ensuing iterations:
Bagnasco et al. [31] made the ensuing conclusions:
Berliner et al. [5] made the ensuing iterations:
Shah et al. [32] made the ensuing iterations:
Shah et al. [32] reported a 63-year-old Caucasian male who had a history of hypertension and who was treated for pulmonary sarcoidosis with a 6-month course of prednisone. His creatinine was 1.6 mg/dL during the course. Two months after completing his treatment, he manifested with creatinine of 4 mg/dL. A kidney biopsy was undertaken and pathology examination of the kidney biopsy specimen showed non-specific changes without evidence of granuloma or active interstitial inflammation. He was empirically commenced on prednisone for a presumed sarcoidosis of the kidney, even with a non-diagnostic kidney biopsy finding. Within a month of treatment, his serum creatinine had improved to 2 mg/dL, even though not to the baseline. He continued to be stable on low-dose prednisone. With this case as a background, Shah et al. [32] aimed to determine the incidence of inconclusive kidney biopsies in patients with sarcoidosis presenting with AKI and to identify the various histological findings seen in this group of patients. Shah et al. [32] therefore, undertook a retrospective study, which involved all patients who had native renal biopsies read at The Ohio State University over the period of 6 years they had identified. Those patients with a diagnosis of sarcoidosis, presenting with AKI, were included for further review. Shah et al. [32] summarised the results as follows:
Shah et al. [32] made the ensuing conclusions:
Agrawal et al. [33] stated that among the various kidney manifestations of sarcoidosis, granulomatous inflammation, which is confined to the tubulointerstitial compartment is the most commonly reported finding. Agrawal et al. [33] reported the case of a 66-year-old man with acute kidney injury, hypercalcemia, mild restrictive pulmonary disease, and neurological signs of parietal lobe dysfunction. Pathology examination of his kidney biopsy specimen demonstrated diffuse interstitial inflammation with non-caseating granulomas which had exhibited the unusual feature of infiltrating the walls of small arteries with destruction of the elastic lamina, consistent with granulomatous vasculitis. The findings of granulomatous interstitial nephritis on kidney biopsy, hypercalcemia, and possible cerebral and pulmonary involvement in the absence of other infectious, drug-induced, or autoimmune causes of granulomatous disease had helped the authors to establish the diagnosis of sarcoidosis. Pulse methylprednisolone followed by maintenance prednisone therapy had led to improvement in the patient’s kidney function, hypercalcemia, and neurologic symptoms. Agrawal et al. [33] concluded that:
Rastelli et al. [3] made the ensuing iterations:
Granulomatous interstitial nephritis in sarcoidosis (sGIN) is generally clinically silent; however, less than one percent (<1>
Rastelli et al. [3] concluded that: sGIN-AKI-patients with no complete recovery at 1°line steroid should be treated with other immunosuppressive in order to avoid CKD, in particular if males who have sub-acute onset and III stage-not hypercalcaemic AKI.
Horino et al. [34] reported a case of acute kidney injury, which was caused by granulomatous interstitial nephritis as a renal manifestation of sarcoidosis proven by renal biopsy, which could be confirmed by 18F-fluorodeoxyglucose positron emission tomography/computed tomography. Horino et al. [34] also reported that Glucocorticoid therapy was helpful for improving and maintaining her renal function over a 6-year period.
Francesco Bonella et al. [35] made the ensuing iterations:
Hilderson et al. [15] made the ensuing iterations:
Wang et al [36] made the ensuing iterations:
The PubMed database was searched by Wang et al [36] for publications, and relevant clinical data were extracted and presented by them as follows:
Wang et al [36] made the ensuing concluding iterations:
Harzallah, Amel et al. [37] reported a case who presented an acute kidney failure and had sarcoidosis with vasculitis and nodular splenic involvement. Harzallah, Amel et al. [37] reported a 35-year-old woman, who manifested with a Lofgren syndrome, who was hospitalized for acute renal failure with cervical lymphadenopathy without other clinical findings. Her laboratory data revealed elevated angiotensin converting enzyme serum level. She had ultrasound scan of her abdomen which demonstrated a multinodular spleen. Pathology examination of her renal biopsy specimen demonstrated granulomatous interstitial nephritis with necrotizing vasculitis. Her outcome was favourable pursuant to the institution of high dose corticosteroids along with cyclophosphamide. Harzallah, Amel et al. [37] made the ensuing concluding iterations:
Akiyama et al. [38] reported a case of renal sarcoidosis manifesting as acute kidney injury (AKI) during treatment with etanercept for rheumatoid arthritis. The patient’s blood test results showed a high level of angiotensin-converting enzyme and a renal biopsy was undertaken following which pathology examination of the biopsy specimen, demonstrated non-caseating granulomatous tubulointerstitial nephritis. The administration of high-dose steroid treatment (1 mg/kg) and discontinuation of etanercept resulted in an improvement in the patient's renal function. Akiyama et al. [38] concluded that:
Kikuchi, et al. [39] made the ensuing iterations:
Kikuchi, et al. [39] reported a case of a 70-year-old man, who had a history of type 2 diabetes mellitus, who was admitted with progressively worsening kidney function. The patient also had exhibited anorexia, malaise and weight loss. His laboratory test results showed an elevated serum lysozyme level, but the serum angiotensin-converting enzyme (ACE) and his serum calcium levels were normal. Increased uptake was evident only in kidney on gallium 67 scintigraphy. Even though typical organ involvement of sarcoidosis was not evident, a renal biopsy was undertaken and pathology examination of the biopsy specimen demonstrated granulomatous interstitial nephritis with non-caseating granulomas. No medications had been added in the 3 years preceding his renal function deterioration. Following a bronchoalveolar lavage that demonstrated a high CD4:CD8 ratio, and a skin test that showed negative result for tuberculin, a diagnosis of sarcoidosis of the kidney was established. On diagnosis, oral prednisolone was commenced and his renal function improved. His anorexia and malaise also disappeared. Kikuchi, et al. [39] concluded that their reported case was an extremely rare case of AKI, which was caused by sarcoid GIN without extra-renal manifestations or elevated serum ACE level.
Rajkumar et al. [40] reported a case series of patients whose diagnosis of sarcoidosis was only brought to light by the development of renal impairment. Concurrent hypercalcaemia was identified which prompted further investigation. The patients subsequently discussed having experienced a significant and rapid improvement in their both renal function and hypercalcaemia in response to treatment with prednisolone. Rajkumar et al. [40] stated that this was out of keeping with previous reports of sarcoidosis-induced renal impairment. Rajkumar et al. [40] made the ensuing conclusions:
Mahévas et al. [41] collected a retrospective data were by the French Sarcoidosis Group. Mahévas et al. [41] assessed forty-seven adult patients (30 male/17 female, M/F ratio: 1.76). Mahévas et al. [41] summarised the results as follows:
Mahévas et al. [41] made the ensuing conclusions:
Mocanu et al. [42] reported the case of a 10-year-old boy who presented with advanced renal failure with nephrocalcinosis and important hepatosplenomegaly. The diagnosis was established by histopathology examination, with consequent cortisone treatment and haemodialysis. Mocanu et al. [42] made the ensuing conclusions:
Sharma et al. [43] reported a case of a 61-year-old woman, who had presented with substernal chest pain. She was found to have elevated calcium levels, anaemia, and acute kidney injury. Her hypercalcemia had persisted despite treatment with fluids and bisphosphonates. She was found to have non-parathyroid hormone (PTH) mediated hypercalcemia. She had chest X-ray, which did not demonstrate any pathology. The authors’ initial impression was likely an underlying haematological malignancy such as lymphoma or multiple myeloma. A bone marrow biopsy was undertaken and pathology examination of the specimen demonstrated non-necrotizing granulomatous inflammation. Her further assessment revealed elevated vitamin 1,25 dihydroxy level, beta-two micro-globulin level, and ACE levels. She had non-contrast computed tomography (CT) scan of chest, which demonstrated bilateral apical bronchiectasis, but did not demonstrate any lymphadenopathy or evidence of malignancy. Subsequently, she had a bronchoscopy with trans-bronchial biopsy, and pathology examination of the biopsy specimen demonstrated non-necrotizing granulomatous inflammation, which was consistent with sarcoidosis. After commencing glucocorticoid treatment, the patient’s hypercalcemia improved and her kidney function returned to baseline.
Charkviani et al. [44] made the ensuing iterations:
Charkviani et al. [44] reported a man in his early 60s with renal cell carcinoma who was undergoing treatment with the ICIs nivolumab and ipilimumab, and who was hospitalized for treatment of acute kidney injury stage 3, hypercalcemia, and hyponatremia 10 weeks after commencing ICI treatment. Charkviani et al. [44] summated the results as follows: Results from his workup showed parathyroid hormone–independent hypercalcemia (ionized calcium, 3.3 mEq/L) with an elevated 1,25-dihydroxyvitamin D level. Pathology examination of his kidney biopsy specimen showed sarcoid-like noncaseating granulomas. The patient commenced a corticosteroid regimen with a 500 mg bolus dose of methylprednisolone and he continued treatment with prednisone, 80 mg once daily for the first week and then a taper for 8 weeks. His kidney function gradually improved as his hypercalcemia resolved. After 2 weeks of treatment, his creatinine values returned to the baseline. Charkviani et al. [44] made the ensuing conclusions:
Singh et al. [45] reported the case of a 55-year-old female patient, who had renal limited sarcoidosis, who manifested with worsening sensorium and acute kidney injury. Results of her investigation demonstrated elevated levels of serum calcium and angiotensinogen converting enzyme; and radiology imaging study of her chest was normal. She had kidney biopsy undertaken for non-resolving acute kidney injury and pathology examination of the biopsy specimen demonstrated non-caseating granulomatous interstitial nephritis and the presence of concurrent Immunoglobulin A (IgA)nephropathy. She responded to a treatment which comprised of fluid resuscitation, hemodialysis, and oral steroids.
Reis Santos et al. [46] reported a 59-year-old woman, who was autonomous in her activities of daily living, and who was admitted to the Multipurpose Emergency Service (MES) with nausea, generalized tremors, and a week-long notion of decreased urine output. She denied having any fever, eye, skin, respiratory, gastrointestinal, or osteoarticular complaints. Her medical history included: hypertension, scleroderma affecting the skin, and hepatic sarcoidosis, with a recent histopathology diagnosis of granulomatous hepatitis after years of follow-up due to altered liver function tests and the exclusion of toxic and infectious aetiology (brucellosis, hepatitis A/B/C, human immunodeficiency virus, syphilis, cytomegalovirus, toxoplasma, and Epstein-Barr virus). She had a poor adherence to sarcoidosis treatment due to her apparent intolerance/skin reactions to previous treatment with corticosteroids, azathioprine, ursodeoxycholic acid, and hydroxychloroquine. Upon clinical examination, she was found to be apyretic and hemodynamically stable, with no alterations on cardiopulmonary auscultation and brief neurological examination. Plaque lesions were identified in her sub-mammary, abdominal, and lower limb regions. There were no signs of inflammation or joint swelling found during her examination. The study which was undertaken on the MES demonstrated normocytic and normochromic anaemia (hemoglobin 11.5mg/dL), acute kidney injury (new-onset creatinine 2.3mg/dL, baseline creatinine 0.8mg/dL and urea 61mg/dL), hypercalcemia (ionized calcium 1.6mEq/L), and high SACE level (serum angiotensin-converting enzyme) of 157U/L. She had ultrasound scan of the renal tract which demonstrated her kidneys to have normal morphology and topography, with a good preservation of sinus-parenchyma differentiation and no alterations to the excretory cavities or obvious images of lithiasis. She was therefore admitted to the Nephrology Ward under medical team for her treatment to correct the hypercalcemia and for monitoring and studying the acute kidney injury in a patient with a history of systemic disease. Her hypercalcemia persisted despite the measures that were instituted, and there was no improvement in her renal function (creatinine 2.4mg/dL and ionized calcium 1.72 mmol/L). Her complementary study was inconclusive (see tables 1 and 2), and a renal biopsy was then undertaken. Faced with the most likely diagnostic hypotheses of acute kidney injury secondary to hypercalcemia and/or intrinsic kidney involvement due to sarcoidosis, after a multidisciplinary discussion with rheumatology, empirical corticosteroid therapy was proposed and she was commenced on methylprednisolone 0.5mg/kg/day. At the time of her discharge, her kidney function and hypercalcemia were stable, and she was referred to the nephrology and systemic autoimmune disease departments of Internal Medicine (given the absence of clinical/systemic and osteoarticular complications) under deflazacort 45mg/day, pantoprazole 20mg, and vitamin D supplementation (addressing her deficiency values), awaiting the results of the renal biopsy. Pathology examination of her renal biopsy specimen demonstrated pathology examination features which confirmed the hypothesized aetiologies. On light microscopy, an interstitial infiltrate of mononuclear cells was evident, which was adjudged to be compatible with acute interstitial nephritis (see figure 2). Acute tubular necrosis was present in 50% of the cortex that was observed, and tubular calcium phosphate crystals were also visualised. Her glomerulus and blood vessels were found to be normal, and the immunofluorescence study was negative. The instituted therapy was maintained.
Table 1: Initial analytical evaluation of acute kidney injury in the nephrology ward
Anti-dsDNA Ac, anti-double stranded DNA antibodies. Reproduced from: [46] under the Creative Commons Attribution License.
Table 2: Complementary study carried out during the diagnostic process
ANA, antinuclear antibodies; ENA, extractable nuclear antigen antibodies; C, complement Reproduced from: [46] under the Creative Commons Attribution License.
Figure 1: Kidney biopsy
Interstitial infiltrate of mononuclear cells, compatible with acute interstitial nephritis. Reproduced from: [46] under the Creative Commons Attribution License.
Two months pursuant to her discharge from the hospital, the patient's renal function, calcium levels, and anaemia had normalized (creatinine 0.9mg/dL, total calcium 4.9mEq/L with albumin 4.4g/dL, and hemoglobin 12.4g/dL), SACE (serum angiotensin-converting enzyme) was normal, and albuminuria was absent. Her corticosteroid treatment was weaned after eight weeks when the disease became stable and after the introduction of azathioprine 75mg twice daily. She maintained her follow-up in both specialties with stabilization of the disease activity and renal function at two years' follow-up under prednisolone 2.5mg and azathioprine 75mg bid, with no record of new organ systems being affected. Her intercurrences included the development of diabetes secondary to corticosteroid therapy, requiring insulin treatment, and the occurrence of osteoporotic fractures requiring vertebroplasty.
Reis Santos et al. [46] made the ensuing conclusions:
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I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
