Association between eosinophilia and renal prognosis in patients with pathologically proven cholesterol crystal embolism

Abstract

Background Approximately, 20-70% of patients with cholesterol crystal embolism (CCE) have eosinophilia. However, it remains unknown how eosinophilia influences renal prognosis in patients with CCE. In this study, we investigated the association between eosinophil count (Eo) and renal prognosis in CCE patients on steroid therapy. Methods The present study is a single-centered retrospective cohort study in patients with renal dysfunction and CCE from April 2007 to May 2018. This study included the patients who were treated with neither maintenance dialysis nor steroid before CCE diagnosis, and followed-up for kidney function until November 2019. We assessed whether eosinophilia at the time of CCE diagnosis was related to renal death after treating with steroid therapy. Results Thirty patients with pathologically diagnosed CCE were enrolled and followed-up for 11.0 (5.2-43.4) months. There were significant differences in the white blood cell count (p = 0.01), hemoglobin (p = 0.009), serum creatinine levels (p = 0.008), phosphate (p = 0.049), and Eo (p = 0.008) between the renal survival and renal death groups. Using the receiver operating characteristic curve analysis with Youden index, Eo of 810/µL showed 100% sensitivity and 69.6% specificity for detecting renal death (area under the curve: 0.839). Comparing the outcomes in patients having Eo ≥ and < 810/µL using the log-rank test, there is a significantly higher renal death rate in CCE patients with Eo ≥ 810/µL (p = 0.0016). Conclusion Higher eosinophilia was a prognostic risk factor for renal death in the patients with CCE.

Association of peripheral eosinophil count with chronic kidney disease progression risk: a retrospective cohort study

“…Various systemic disorders affecting kidney function, such as cholesterol embolization syndrome (CES), may be accompanied by eosinophilia [19,20]. Generally, the incidence of eosinophilia in patients with CES ranges from 14-71% [21]. Patients with CES with kidney involvement showed an even greater increase in the eosinophilic granulocyte count [22], suggesting a potential link between eosinophilic granulocytes and the kidneys.…”

“…Eosinophilic granulocytes are activated by in ammatory mediators such as interleukin (IL)-3 and IL-5, which increase their circulation for approximately 18-24 h before migrating from the blood vessels. The mechanisms of the damage caused by eosinophilic granulocytes include: 1) the release of particulate products such as alkaline proteins, which can damage epithelial tissue and cause in ammation, and 2) the release of platelet-activating factor, cytokines, and chemokines, further triggering tissue remodeling and brosis [21,27]. Makiya et al [28] observed a correlation between the eosinophilic granulocyte count and CD69 and granule protein concentration.…”

Review of Peripheral Blood Eosinophilia: Workup and Differential Diagnosis

“…Cholesterol crystal embolism (CCE) has also been associated with peripheral eosinophilia. It has been found in some studies that around 20-70% of patients with CCE have peripheral eosinophilia [53][54][55].…”

Eosinophils: A Friend or Foe in Human Health and Diseases

“…In a relatively recent case-control study by Tariq et al [ 110 ], they demonstrated that peripheral eosinophilia is an independent predictor of tissue eosinophilia and subsequent progression to end-stage kidney disease. Given that ∼20–70% of cholesterol crystal embolism patients present eosinophilia [ 111 , 112 , 113 , 114 , 115 , 116 ], Mochida et al [ 117 ] demonstrated in a single-centered cohort study that eosinophilia served as a prognostic factor for renal death among cholesterol crystal embolism patients. Besides, Gauckler and colleagues [ 118 ] also reviewed acute or chronic kidney diseases and other special condition associated with eosinophilia.…”