Eosinophilia and Kidney Disease: More than Just an Incidental Finding?

• Type of Material: Article
• Authors: Philipp Gauckler, Medical University of Innsbruck; Jae Shin, Emory University; Gert Mayer, Medical University of Innsbruck; Andreas Kronbichler, Medical University of Innsbruck
• Language: English
• Date: 2018-12-01
• Publisher: MDPI
• Publication Version: Final Published Version
• Copyright Statement: © 2018 by the authors.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3390/jcm7120529
• Title of Journal or Parent Work: Journal of Clinical Medicine
• ISSN: 2077-0383
• Volume: 7
• Issue: 12
• Grant/Funding Information: This research received no external funding.
• Keywords: Life Sciences & Biomedicine; EGPA; General & Internal Medicine; Medicine, General & Internal; AKI; ORGAN TRANSPLANT RECIPIENTS; CHOLESTEROL EMBOLIZATION SYNDROME; ANTINEUTROPHIL CYTOPLASMIC ANTIBODIES; AMBULATORY PERITONEAL-DIALYSIS; IgG4-related disease; ACUTE INTERSTITIAL NEPHRITIS; ATHEROEMBOLIC RENAL-DISEASE; interstitial nephritis; vasculitis; CHURG-STRAUSS-SYNDROME; autoimmune disease; Science & Technology; eosinophilia; kidney disease; STRONGYLOIDES-STERCORALIS INFECTION; SYSTEMIC-LUPUS-ERYTHEMATOSUS; CKD; DONOR-DERIVED STRONGYLOIDIASIS
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Peripheral blood eosinophilia (PBE), defined as 500 eosinophils or above per microliter (µL) blood, is a condition that is not uncommon but often neglected in the management of patients with chronic kidney disease (CKD), acute kidney injury (AKI), or patients on renal replacement therapy (RRT). The nature of PBE in the context of kidney diseases is predominantly secondary or reactive and has to be distinguished from primary eosinophilic disorders. Nonetheless, the finding of persistent PBE can be a useful clue for the differential diagnosis of underdiagnosed entities and overlapping syndromes, such as eosinophilic granulomatosis with polyangiitis (EGPA), IgG4-related disease (IgG4-RD), acute interstitial nephritis (AIN), or the hypereosinophilic syndrome (HES). For patients on RRT, PBE may be an indicator for bio-incompatibility of the dialysis material, acute allograft rejection, or Strongyloides hyperinfection. In a subset of patients with EGPA, eosinophils might even be the driving force in disease pathogenesis. This improved understanding is already being used to facilitate novel therapeutic options. Mepolizumab has been licensed for the management of EGPA and is applied with the aim to abrogate the underlying immunologic process by blocking interleukin-5. The current article provides an overview of different renal pathologies that are associated with PBE. Further scientific effort is required to understand the exact role and function of eosinophils in these disorders which may pave the way to improved interdisciplinary management of such patients.