Concurrent Kidney Glomerular and Interstitial Lesions Associated with Kimura’s Disease

Abstract

<b><i>Background:</i></b> Kimura disease (KD) is a chronic benign inflammatory disorder that is usually manifested as a deep, subcutaneous mass with or without regional lymphadenopathy in the head and neck region. Various types of glomerulonephritis are associated with KD, including minimal change disease (MCD), membranous glomerulopathy (MN), and immunoglobulin (Ig)A-nephropathy. Kidney interstitial lesion associated with KD is rarely reported. The aim of this study was to expand the spectrum of kidney lesions associated with KD. <b><i>Methods:</i></b> From 2007 to 2016, 12 cases of KD with kidney lesions were retrospectively reviewed. Pathological examinations included hematoxylin and eosin staining, periodic acid-schiff staining, periodic acid-methenamine silver staining, and Masson staining, immunofluorescence, and electron microscope analyses. <b><i>Results:</i></b> Anatomic sites of subcutaneous involvement included head and neck area, arm, and groin. Most cases had elevated IgE level and peripheral eosinophilia. Nephrotic syndrome was the most common kidney manifestation. Pathological results showed 3 types of glomerulonephritis, including 9 cases of MCD, 2 cases of IgA nephropathy, and 1 case of MN. Of note, 4 MCD cases showed concurrent glomerular and interstitial lesions associated with KD, including 2 distinct patterns: (1) a diffusely eosinophilic and lymphatic infiltration similar to KD lesion developed elsewhere and (2) exclusively eosinophilic infiltration in the interstitium. Eight out of 10 patients were responsive to steroid treatment and had complete remission of proteinuria and recovery of kidney function. <b><i>Conclusion:</i></b> Our report suggested that, in addition to glomerulonephritis, interstitial lesions may also be associated with KD. Pathologist should pay special attention to differentiated diagnosis when such pathological changes are identified in patients with subcutaneous mass or cervical lymphadenopathy with concurrent kidney manifestation.

Signaling through tumor necrosis receptor 2 induces stem cell marker in CD133+ regenerating tubular epithelial cells in acute cell-mediated rejection of human renal allografts

“…Although Banff grade II rejections involved arteries as well as tubules, the extent of tubular injury was at least equivalent to that in grade I biopsy samples. Periodic acid–Schiff silver stain 38 clearly shows marked injury in tubules with lymphocytic infiltration in ACR (insets, Figure 1B‐D). In contrast, H&E‐stained sections of ATI showed tubules with epithelial injury, luminal dilatation, nuclear loss, and nuclear pyknosis with no obvious mononuclear cell infiltration (Figure 1F).…”

Disease characteristics of 70 patients with Kimura disease

“…Both patients received oral corticosteroids therapy, but the latter progressed to end-stage renal disease as a result of self-discontinuation. In our study, renal puncture was performed in 3 patients and the pathologic nding was minimal change disease, including 1 patient who also had IgA nephropathy and small focal scattered eosinophil in ltrates in the renal interstitium [11] , which may be a typical change resulting from eosinophil invasion. Four patients (cases 3, 5, 8, and 12) developed nephrotic syndrome before the diagnosis of KD, and case 8 underwent renal transplantation for renal failure.…”

Challenging diagnosis of Kimura disease in a child with nephrotic syndrome: A case report

“…In younger patients with localized lesions, surgical excision is typically the first‐line choice for treatment and diagnostic purposes 2 . Furthermore, nephrotic syndrome relapse might be suppressed with the early excision of the KD masses 25 …”