Eosinophil elevation has been hypothesized to cause tissue and organ damage by cytotoxic effects from reactive oxygen species, and other proteins. Production of eosinophils is closely related with inflammation and the immune response to parasitic illness, asthma, hypersensitivity reactions and allergic responses. Peripheral eosinophilia may be an early biomarker for underlying inflammation and disease, but further studies to investigate this clinical association are warranted. Peripheral eosinophilia is an independent predictor of tissue eosinophilia and subsequent progression to ESKD. Peripheral eosinophilia had a significant linear association with kidney tissue eosinophils, 22 (standard deviation 20) per high power field (hpf) in 4–10% peripheral eosinophilia, 19 (SD 18) per hpf in ≥10% eosinophilia and 3 (SD 7) per hpf in no eosinophilia ( P < 0.001). Peripheral eosinophilia was associated with higher risk of ESKD (OR 15.9 ) adjusted for patient demographics including hypertension, proteinuria and eGFR at the time of kidney biopsy. Compared to patients without eosinophilia, patients with peripheral eosinophilia were notably male and had a higher serum creatinine at the time of their biopsy. ResultsĪmong 178 patients, 65 (37%) had peripheral eosinophilia and 113 (63%) had no eosinophilia. The association of peripheral eosinophilia (> 4% of peripheral blood leukocytes) with the risk of progression to ESKD was evaluated using conditional logistic model after adjusting for clinical demographics.
Controls ( n = 154) had no ESKD at the time of case ( n = 24) designation and were assembled using incident density sampling and matched on age and sex. From the 616 eligible patients, 178 patients were identified through the registry of kidney biopsies as 18 years or older without missing biopsy reports or hematology results. MethodsĪ nested case-control (2:1) of patients who underwent kidney biopsies at Johns Hopkins Hospital and Medical University of South Carolina from 2004 to 2018 were included in the study. We evaluated the presence of peripheral eosinophilia (> 4% of blood leukocytes) with biopsy tissue eosinophilia and their association with end-stage-kidney-disease (ESKD). The significance of eosinophilia in renal diseases has not been well addressed.
Eosinophilia in blood and renal biopsy tissue is associated with a host of immune and non-immune kidney diseases. Eosinophils in kidney disease are poorly understood and are often incidental findings on kidney biopsy.
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