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Background Eosinophils in kidney disease are poorly understood and are often incidental findings on kidney biopsy. Eosinophilia in blood and renal biopsy tissue is associated with a host of immune and non-immune kidney diseases. The significance of eosinophilia in renal diseases has not been well addressed. We evaluated the presence of peripheral eosinophilia (>4% of blood leukocytes) with biopsy tissue eosinophilia and their association with end-stage-kidney-disease (ESKD). Methods A nested case-control (2:1) of patients who underwent kidney biopsies at Johns Hopkins Hospital and Medical University of South Carolina from 2004-2018 were included in the study. 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. 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. 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. Results Among 178 patients, 65 (37%) had peripheral eosinophilia and 113 (63%) had no eosinophilia. Compared to patients without eosinophilia, patients with peripheral eosinophilia were notably male and had a higher serum creatinine at the time of their biopsy. Peripheral eosinophilia was associated with higher risk of ESKD (OR 15.9 1.9, 134.7) adjusted for patient demographics including hypertension, proteinuria and eGFR at the time of kidney biopsy. Peripheral eosinophilia had a significant linear association with kidney tissue eosinophils, 22 (standard deviation SD 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). Conclusions Peripheral eosinophilia is an independent predictor of tissue eosinophilia and subsequent progression to ESKD. Peripheral eosinophilia may be an early biomarker for underlying inflammation and disease, but further studies to investigate this clinical association are warranted.
Keywords
eosinophilia, kidney biopsy, interstitial nephritis, end-stage-kidney-disease, inflammation
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CURRENT STATUS: Published
View the published article at BMC Nephrology.
Version 3
Posted 09 Jan, 2020
No community comments so far
Editorial decision: Accept
On 03 Jan, 2020
Editor assigned
On 02 Jan, 2020
Submission checks complete
On 01 Jan, 2020
Editor invited
On 01 Jan, 2020
No comments provided
Editorial decision: Minor revision
On 24 Dec, 2019
Reviewer #1 agreed
On 02 Dec, 2019
Reviewer #2 agreed
On 02 Dec, 2019
Review #1 received
Received 02 Dec, 2019
Review #2 received
Received 02 Dec, 2019
Reviewers invited
Invitations sent on 01 Dec, 2019
Editor assigned
On 28 Nov, 2019
Submission checks complete
On 27 Nov, 2019
Editor invited
On 27 Nov, 2019
No comments provided
Editorial decision: Major revision
On 28 Oct, 2019
Review #2 received
Received 21 Sep, 2019
Review #1 received
Received 21 Sep, 2019
Reviewer #2 agreed
On 20 Sep, 2019
Reviewers invited
Invitations sent on 26 Aug, 2019
Reviewer #1 agreed
On 26 Aug, 2019
Submission checks complete
On 15 Aug, 2019
Editor assigned
On 22 Jul, 2019
Editor invited
On 21 Jul, 2019
First submitted
On 19 Jul, 2019
Metrics
Comments: 0
PDF Downloads: ...
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Subject Areas
Urology & Nephrology
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See the published version of this preprint at BMC Nephrology.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Nephrology.
Version 3
Posted 09 Jan, 2020
No community comments so far
Editorial decision: Accept
On 03 Jan, 2020
Editor assigned
On 02 Jan, 2020
Submission checks complete
On 01 Jan, 2020
Editor invited
On 01 Jan, 2020
No comments provided
Editorial decision: Minor revision
On 24 Dec, 2019
Reviewer #1 agreed
On 02 Dec, 2019
Reviewer #2 agreed
On 02 Dec, 2019
Review #1 received
Received 02 Dec, 2019
Review #2 received
Received 02 Dec, 2019
Reviewers invited
Invitations sent on 01 Dec, 2019
Editor assigned
On 28 Nov, 2019
Submission checks complete
On 27 Nov, 2019
Editor invited
On 27 Nov, 2019
No comments provided
Editorial decision: Major revision
On 28 Oct, 2019
Review #2 received
Received 21 Sep, 2019
Review #1 received
Received 21 Sep, 2019
Reviewer #2 agreed
On 20 Sep, 2019
Reviewers invited
Invitations sent on 26 Aug, 2019
Reviewer #1 agreed
On 26 Aug, 2019
Submission checks complete
On 15 Aug, 2019
Editor assigned
On 22 Jul, 2019
Editor invited
On 21 Jul, 2019
First submitted
On 19 Jul, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Urology & Nephrology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Nephrology.
Background Eosinophils in kidney disease are poorly understood and are often incidental findings on kidney biopsy. Eosinophilia in blood and renal biopsy tissue is associated with a host of immune and non-immune kidney diseases. The significance of eosinophilia in renal diseases has not been well addressed. We evaluated the presence of peripheral eosinophilia (>4% of blood leukocytes) with biopsy tissue eosinophilia and their association with end-stage-kidney-disease (ESKD). Methods A nested case-control (2:1) of patients who underwent kidney biopsies at Johns Hopkins Hospital and Medical University of South Carolina from 2004-2018 were included in the study. 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. 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. 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. Results Among 178 patients, 65 (37%) had peripheral eosinophilia and 113 (63%) had no eosinophilia. Compared to patients without eosinophilia, patients with peripheral eosinophilia were notably male and had a higher serum creatinine at the time of their biopsy. Peripheral eosinophilia was associated with higher risk of ESKD (OR 15.9 1.9, 134.7) adjusted for patient demographics including hypertension, proteinuria and eGFR at the time of kidney biopsy. Peripheral eosinophilia had a significant linear association with kidney tissue eosinophils, 22 (standard deviation SD 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). Conclusions Peripheral eosinophilia is an independent predictor of tissue eosinophilia and subsequent progression to ESKD. Peripheral eosinophilia may be an early biomarker for underlying inflammation and disease, but further studies to investigate this clinical association are warranted.
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