Renal involvement in a patient with idiopathic hypereosinophilic syndrome

Bulucu, Fatih; Can, Cevat; Inal, Vedat; Baykal, Yavuz; Erikçi, Selahattin

doi:10.5414/cnp57171

Cited by 13 publications

(13 citation statements)

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“…However, it is thought to be similar to histologic involvement by HES on other organs by mass effect due to the proportion of eosinophils and eosinophil cytotoxicity (2). In fact, these reports are characterized by eosinophilic infiltration in renal biopsy, which does not occur in our patient (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). While focal segmental glomerulosclerosis and HES may be two coexisting diseases-yet unrelated in our patient-the low proportion of cases reported in the literature of glomerular involvement of HES, compels us to consider the possibility of physiopathological mechanisms not yet known may account for such coexistence.…”

Section: Discussionsupporting

confidence: 53%

Focal segmental glomerulosclerosis in a patient with hypereosinophilic syndrome

Herrera-Añazco¹,

Matias-tasayco

Arellano-Bravo

et al. 2017

J Nephropathol

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Background: Renal complication in hypereosinophilic syndrome (HES) is rare, with literature scarcely reporting association of this syndrome with glomerular involvement. While the direct effect of eosinophilic infiltration in tissues has been linked to histological damage of the HES, other mechanisms may account for renal involvement too. Case Presentation: We present a case of a 17-year-old male patient, with progressive edema, contact reactive erythematous skin lesions, acute kidney injury, nephrotic syndrome and progressive eosinophilia. His bone marrow biopsy revealed moderate hyperplasia with severe eosinophilia and atypical lymphocytes. His renal biopsy revealed glomeruli, enlarged in volume with mesangial expansion and hypercellularity and segmental thickening of capillary loops. Likewise, some glomeruli showed peripheral hyalinosis with synechiae to Bowman's capsule. Tubules showed cloudy swelling, mild tubular atrophy and hyaline cylinders. Interstitial area showed infiltrated lymphomononuclear cells, focal with no evidence of eosinophils. Blood vessels were unaltered. Immunofluorescence identified glomeruli with granular mesangial IgM deposition. After corticosteroid treatment, eosinophilia and creatinine values regress to normal range. Conclusions: While our case may suggest the coexistence of two unrelated diseases, further studies are required to assess the pathophysiology of glomerular involvement in HES. Given the possibility that mechanisms other than the direct effect of eosinophils are involved in certain patients

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Section: Discussionsupporting

confidence: 53%

Focal segmental glomerulosclerosis in a patient with hypereosinophilic syndrome

Herrera-Añazco¹,

Matias-tasayco

Arellano-Bravo

et al. 2017

J Nephropathol

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“…However, it should be emphasized that atheroembolism-associated hypereosinophilia is not part of the HES; eosinophilia is incidental and not required to make the diagnosis of atheroembolism. HES is also associated with crescentic, and immunotactoid glomerulonephritis [11,12] (summarized in Table 2) with IgG, IgM, IgA, and C3 glomerular deposits in some cases, while in others, similar to the patients described here, with absent immune deposits [5]. Interestingly, while a relationship between HES and thrombosis has been recognized, an association of hypereosinophilia with renal TMA is not established.…”

Section: Discussionmentioning

confidence: 60%

“…Kidney disease is thought to be rare in HES [3]. In previously reported HES cases, renal pathology is either poorly described, or nonspecific [5][6][7]. One report noted that as many as one in five HES patients develops proteinuria and hypertension [8].…”

Section: Discussionmentioning

confidence: 98%

Thrombotic microangiopathy associated with the hypereosinophilic syndrome

Liapis

Brown

et al. 2005

Kidney International

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“…Renal involvement can present as renal dysfunction [5,6] or proteinuria [10], which can range from subnephrotic to nephrotic range [11]. Our case presented with renal dysfunction with serum creatinine of 1.7 and creatinine clearance of 44 ml/min.…”

Section: Discussionmentioning

confidence: 99%

“…Various histological patterns reported by various authors include Ischemic lesions secondary to intrarenal thrombus formation [13], crescentic glomerulonephritis [14], mesangial expansion [15], proliferative glomerulonephritis [13], immuno-tactoid glomerulopath [11], glomerular sclerosis [6], interstitial nephritis with eosinophilic infil-trates [8,10] and membranous nephropathy [11]. Findings on immunofluorescence of renal biopsy in patients with IHES vary with deposition of immune complex and complement in some cases and lack of their deposition in others.…”

Section: Discussionmentioning

confidence: 99%

Idiopathic Hypereosinophilic Syndrome Presenting as IgA Nephropathy with Nephrotic Range Proteinuria

Shah¹,

Koul²,

Shah³

et al. 2013

OJNeph

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Idiopathic hypereosinophilic syndrome (IHES) is a disorder characterized by increased eosinophil count (eosinophilia) along with organ dysfunction secondary to organ infiltration of eosinophils and release of inflammatory markers [1][2][3][4], with no obvious cause for eosinophilia. The onset of symptoms is insidious in most of the cases and eosinophilia is detected incidentally. However, in others, the initial manifestations are severe and life-threatening due to the rapid evolution of cardiac or neurologic complications [5]. Renal involvement is rarely reported [6] in IHES. Herein we reported a case of IHES with predominant renal involvement as nephrotic syndrome with focal necrotizing IgA nephropathy.Keywords: Idiopathic Hypereosinophilic Syndrome; Eosinophilia; Renal Involvement; Nephrotic Syndrome Case ReportA 50-year old male presented with a 3-week history of a non-productive cough, associated with intermittent low grade fever, periorbital puffiness and lower extremity edema. Patient denied any history of breathlessness, chest-pain, hemoptysis, orthopnea, paroxysmal nocturnal dyspnea, drop in urine output, skin rash or arthritis. His past history was insignificant and he denied any history of drug intake.Hisexamination revealed mild pallor, with periorbitalpuffiness, lower extremity pitting edema and mild splenomegaly. He had hemoglobin of 11 g/dL with a total leucocyte count of 9.2 × 10 9 /cumm and an ESR of 23 mmhr. His differential count included 46% polymorphs 11% lymphocytes and 41% eosinophils with AEC count of 3800 which repeatedly was high and ranged from 3800 to 5500. A peripheral blood film showed features of normochromic normocytic anaemia with no abnormal cells. His serum creatinine was 1.7 mg/dL with a creatinine clearance of 44 ml/min. Liver functions showed hypoporoteinemia with hypoalbuminemia. He had an active urinary sedimentand urine which showed presence of eosinophils on wright's staining. 24 hours urinary protein was 5.04 g/24hours which was reproduced twice. Repeated stool examination for the presence of ova/parasite was negative.Radiograph of the chest was normal. High resolution computerized tomography of the chest did not reveal any abnormality. His electrocardiograph and echocardiography were normal. Ultrasonography of abdomen was normal as well.Patient was investigated further to look for eosinophilic infiltration of other organ systems in view of persistant hypereosinophilia.Patient was subjected to bronchoscopy to obtain bronchoalveolar lavage for eosinophils which revealed 62% eosinophils. Bone marrow aspiration and biopsy revealed 56% eosinophils with no dysplasia and blasts. p-ANCA andc-ANCA were within normal limits. Serum tryptase levels were within normal limits.Patient was subjected to percutaneous renal biopsy to look for the etiology of nephrotic range proteinuria. Renal biopsy revealed, marked interstitial edema and patchy inflammation including aggregates of eosinophils admixed with mononuclear cells and occasional neutrophils. An eosinophilic infiltrate wa...

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Renal involvement in a patient with idiopathic hypereosinophilic syndrome

Cited by 13 publications

References 0 publications

Focal segmental glomerulosclerosis in a patient with hypereosinophilic syndrome

Focal segmental glomerulosclerosis in a patient with hypereosinophilic syndrome

Thrombotic microangiopathy associated with the hypereosinophilic syndrome

Idiopathic Hypereosinophilic Syndrome Presenting as IgA Nephropathy with Nephrotic Range Proteinuria

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