Abstract: SA-PO1112
Hypereosinophilic Syndrome with Kidney and Bladder Involvement: A Case of Reduced GFR and Thickened Bladder Wall Responding to Low-Dosage Steroids
Session Information
- Geriatric Nephrology
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Geriatric Nephrology
- 1300 Geriatric Nephrology
Authors
- Bhatt, Anil Prasad, Renacare Center For Kidney Disease and Research, Noida, UP, India
- Gupta, Bheem Raj, Sharda University, Greater Noida, UP, India
Group or Team Name
- Renacare.
Introduction
Hypereosinophilic syndrome (HES) is defined by persistent eosinophilia (>1.5 billion /L) and organ involvement [1]. Renal manifestations are rare, occurring in 20% of cases, while bladder involvement is exceptional [2]. We report a case of HES with renal dysfunction, anemia, and bladder wall thickening in a patient with comorbidities, highlighting the need for tailored corticosteroid therapy in complex cases.
Case Description
A 74-year-old male with coronary artery disease (post-angioplasty) and bronchial asthma (12 years) presented with abdominal distension. Colonic biopsy showed eosinophilic colitis; skin biopsy confirmed leukocytoclastic vasculitis. Labs revealed eosinophilia (2.8 billion /L), creatinine 1.7 mg/dL (eGFR 32 mL/min/1.73 sq m, baseline 62 mL/min/1.73 sq m), hypoalbuminemia (2.01 g/dL), anemia, and ESR >100 mm/hr. CT showed a thickened bladder wall, suggesting eosinophilic cystitis. Kidney biopsy was deferred due to anticoagulation (clopidogrel). HES was diagnosed based on eosinophilia and multi-organ involvement. Methylprednisolone 32 mg daily caused bloating; 16 mg was intolerable, but 8 mg was effective, later reduced to 4 mg. This improved symptoms, normalized eosinophil count (1.2 billion /L), GFR (62 mL/min/1.73 sq m), creatinine (1.1 mg/dL), albumin (3.5 g/dL), anemia, and ESR.
Discussion
This case highlights HES with rare renal and bladder involvement. Reduced GFR (32 mL/min/1.73 sq m) and creatinine (1.7 mg/dL) suggest eosinophilic nephritis [2]. Bladder wall thickening indicates eosinophilic cystitis, a novel HES finding [3]. Anemia and ESR (>100 mm/hr) reflect systemic inflammation. High-dose methylprednisolone (32 mg) worsened gut symptoms, likely due to HES-related colitis [4]. Low-dose (4 mg) therapy normalized eosinophil count, GFR, creatinine (1.1 mg/dL), albumin, anemia, and ESR, showing a threshold effect [1]. Anticoagulation precluded kidney biopsy, emphasizing clinical diagnosis in HES. Individualized therapy is crucial in elderly patients with comorbidities like CAD and asthma, where corticosteroid intolerance complicates management.
References :
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