Clinical and morphologic spectrum of renal involvement in idiopathic hypereosinophilic syndrome

Jianhua, Dong; Xu, Shutian; Xu, Feng; Yuchao, Zhou; Li, Ze; Li, Shijun

doi:10.1007/s10157-020-02012-5

Cited by 8 publications

(13 citation statements)

References 17 publications

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“…Contrary to the previous belief that eosinophilic infiltrations are observed in limited etiologies such as drug-induced interstitial nephritis, eosinophilic granulomatosis with polyangiitis, 28 and idiopathic hypereosinophilic syndrome, 29,30 interstitial eosinophilic aggregates have been detected in various kidney diseases including diabetic nephropathy, IgA nephropathy, membranous nephropathy, FSGS, and membranoproliferative glomerulonephritis. 11 In our study, interstitial eosinophilic aggregates were also found in nephrosclerosis and lupus nephritis.…”

Section: Discussioncontrasting

confidence: 78%

Interstitial Eosinophilic Aggregates and Kidney Outcome in Patients with CKD

Hattori,

Sakaguchi,

Oka

et al. 2023

CJASN

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Background Interstitial eosinophilic aggregates are observed in various kidney diseases, but their clinical implications remain unknown. We assessed the association between interstitial eosinophilic aggregates and kidney outcomes and further analyzed the association between blood eosinophil count, as a surrogate for interstitial eosinophilic aggregates, and the risk of kidney failure in patients with advanced CKD. Methods We analyzed datasets from two retrospective cohort studies: (1) the kidney biopsy cohort including 563 patients who underwent native kidney biopsy at Osaka University Hospital between 2009 and 2021 and (2) the retrospective CKD cohort including 2877 patients with an eGFR of 10–60 ml/min per 1.73 m2 referred to the nephrology outpatient center at Osaka University Hospital between 2005 and 2018. Interstitial eosinophilic aggregates were defined as ≥5 interstitial eosinophils in the high-power field on hematoxylin and eosin staining. This study outcome was initiation of KRT or ≥40% decline in eGFR. Results In the kidney biopsy cohort, interstitial eosinophilic aggregates were found in 17% of patients, most frequently in those with diabetic nephropathy (50%). Interstitial eosinophilic aggregates were associated with a higher rate of the composite kidney outcome after adjustment for clinical and histological variables (hazard ratio, 3.61; 95% confidence interval, 2.47 to 5.29; P < 0.001). LASSO revealed that blood eosinophil count was the strongest predictor of interstitial eosinophilic aggregates. In the retrospective CKD cohort, higher baseline and time-updated blood eosinophil counts were significantly associated with a higher rate of KRT initiation in Cox proportional hazards models and marginal structural models. Conclusions Interstitial eosinophilic aggregates were associated with a higher risk of a composite of KRT initiation or ≥40% decline in eGFR.

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Section: Discussioncontrasting

confidence: 78%

Interstitial Eosinophilic Aggregates and Kidney Outcome in Patients with CKD

Hattori,

Sakaguchi,

Oka

et al. 2023

CJASN

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“…Eosinophilic granulocytes are common in CKD, and they are associated with systemic disorders that can lead to kidney damage and eosinophilia. 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].…”

Section: Discussionmentioning

confidence: 99%

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

Ren,

Zhang,

et al. 2024

Preprint

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Background: Eosinophilia is common in renal diseases; however, the role of peripheral eosinophils in chronic kidney disease (CKD) requires further evaluation. Therefore, we aimed to determine whether an eosinophil count increase is related to the occurrence of end-stage renal disease (ESRD). Methods: This single-center, observational, retrospective study was conducted between January 2016 and December 2018 in Hangzhou, China. The study included 3163 patients, categorized into four groups according to peripheral eosinophil count (PEC) quartile values (Q1 PEC, ≤0.0625×109/L; Q2, 0.0625–0.1223×109/L; Q3, 0.1224–0.212×109/L; Q4, ≥0.212×109/L). The main outcome was ESRD development during follow-up. We evaluated the relationship between serum eosinophil count, demographic and clinical information, and ESRD incidence. Cox proportional hazards models were used to examine the association between the PEC and risk of progression to ESRD. Kaplan-Meier survival curves were compared between Q1 and Q4 PECs using the log-rank test. Results: A total of 3163 patients with CKD were included in this cohort, of whom 1254 (39.6%) were female individuals and the median (interquartile range [IQR]) age was 75 [64, 85] years and the median (IQR) estimated glomerular filtration rate was 55.16 [45.19, 61.19] mL/min/1.73 m2. The median PEC was 0.1224×109/L (IQR, 0.0625–0.212). Among the 3163 patients with CKD, 273 (8.6%) developed ESRD during a median follow-up time of 443.8 [238.8, 764.9] days. Individuals in the highest PEC quartile had a 66.2% higher ESRD risk than those in the lowest quartile (hazard ratio, 1.662; 95% confidence interval, 1.165–2.372). The results from the Kaplan-Meier survival curves confirmed the conclusion. Conclusions: Alongside traditional risk factors, patients with CKD and an elevated PEC are more likely to develop ESRD. Therefore, more attention should be paid to those patients with CKD who have a high PEC.

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“…Another possible explanation is that eosinophils may be involved in tubulointerstitial injury. Interstitial eosinophilic in ltration is typically observed in drug-induced tubulointerstitial nephritis, eosinophilic granulomatosis with polyangiitis 12 , tubulointerstitial nephritis with uveitis 43 , and idiopathic hypereosinophilic syndrome 10,11 . Interestingly, interstitial eosinophilic aggregates are also found in common kidney diseases, and are associated with IFTA, interstitial edema, and eosinophilic tubulitis, suggesting that they may aggravate tubulointerstitial in ammation and brosis 13,14 .…”

Section: Discussionmentioning

confidence: 99%

“…In addition to their proatherogenic property, eosinophils might also contribute to the progression of kidney disease. For example, renal complications sometimes develop in idiopathic hypereosinophilic syndrome, where tubulointerstitial in ltration of eosinophils is typically observed 10,11 . Eosinophilic granulomatosis with polyangiitis, characterized by the interstitial in ltration of eosinophils, is also evidentiary to the involvement of eosinophils in kidney injury 12 .…”

Section: Introductionmentioning

confidence: 99%

Association between Time-Updated Eosinophil Counts and Progression of CKD

Hattori

Sakaguchi

Oka

et al. 2022

Preprint

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Patients with chronic kidney disease (CKD) have high blood eosinophil count but its clinical implication is uncertain. Since eosinophils may induce tubulointerstitial injury and arteriosclerosis, eosinophilia might be related to poor clinical outcomes. This retrospective cohort study included 2,877 patients whose estimated glomerular filtration rate (eGFR) was 10–60 mL/min/1.73 m2. The exposure was time-updated blood eosinophil counts. The outcomes were 1) initiation of renal replacement therapy (RRT) and 2) cardiovascular events and mortality. We analyzed the associations between eosinophil counts and outcomes using marginal structural models (MSM). Over a median follow-up of 6.5 years, eosinophil counts were measured a median of 22 times per patient (4 times a year per patient). There was a negative correlation between eosinophil count and eGFR. In total, 433 patients initiated RRT, 275 developed cardiovascular events, and 165 died. In MSM, higher eosinophil counts (≥ 289/µL) showed a 1.83-fold (95% confidence interval:1.33–2.51) higher rate of RRT initiation than lower eosinophil counts after adjustment for time-dependent confounders. Higher eosinophil counts were also associated with a higher rate of cardiovascular events and mortality in MSM (hazard ratio, 1.71 [95% confidence interval:1.30–2.25]). In conclusion, patients with CKD who had higher eosinophil counts showed worse kidney outcome.

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Clinical and morphologic spectrum of renal involvement in idiopathic hypereosinophilic syndrome

Cited by 8 publications

References 17 publications

Interstitial Eosinophilic Aggregates and Kidney Outcome in Patients with CKD

Interstitial Eosinophilic Aggregates and Kidney Outcome in Patients with CKD

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

Association between Time-Updated Eosinophil Counts and Progression of CKD

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