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Kidney Week

Abstract: SA-PO1082

Histopathologic Spectrum of Kidney Biopsies in Patients with Eosinophilia

Session Information

Category: Pathology and Lab Medicine

  • 1502 Pathology and Lab Medicine: Clinical

Authors

  • Tariq, Anam, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Delsante, Marco, Johns Hopkins Pathology , Baltimore , Maryland, United States
  • Atta, Mohamed G., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • McMahon, Blaithin A., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
Background

Eosinophilia has been linked to diseases including interstitial nephritis (IN) and other autoimmune diseases in many case reports. However, no kidney biopsy series has examined the predictive role of peripheral eosinophilia and tissue eosinophilia within kidney biopsies in patient’s with established kidney disease. This study evaluated a large series of kidney biopsies with known eosinophilia to better define the spectrum of kidney disease in this patient population.

Methods

A retrospective review of native and allotransplant kidney biopsies obtained from 1996 to 2018 identified 58 patients with eosinophilia (serum as a percentage of circulating leukocytes >4% on hematology). Patient characteristics, clinical and laboratory data were obtained. Standard processing of all biopsy specimens included light microscopy, immunofluorescence, and electron microscopy, focusing on the number of inflammatory markers including tissue eosinophils, number per high field (hpf), was performed.

Results

While IN was the most common primary diagnosis, other diagnoses include FSGS (17%), ANCA (14%), hypertensive arteriosclerosis (9%) (Table 1). Of the 58 patients, the most common indication for kidney biopsy was acute (51%), acute on chronic kidney failure (41%) and subnephrotic protrinuria (53%).In IN, mean eosinophilia was 13% and mean kidney tissue eosinophil number was 12 per hpf . In FSGS, mean eosinophilia was 14% and mean kidney tissue eosinophil number was higher at 18 per hpf. Outcomes show 17% of IN and 5% of FSGS patients progressed to ESRD.

Conclusion

Eosinophilia is seen in a spectrum of kidney diseases other than IN, such as FSGS and hypertensive arteriosclerosis. The role of eosinophilia in predicting major adverse kidney events requires further investigation.

Primary kidney biopsy findings in patients with peripheral Eosinophilia
Diagnosis (n/N)
Interstitial nephritis (acute and chronic)29/58
FSGS 10/58
ANCA8/58
Hypertensive/arteriosclerosis5/58
Diabetic nephropathy4/58
Membranous glomerulopathy2/58
IgG4 disease 1/58
Minimal-change disease 1/58
AA amyloid1/58
Thrombotic microangiopathy1/58