Eosinophilia and Risk of Incident End Stage Kidney Disease

Abstract 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 incidence 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 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 had no ESKD at the time of case definition and assembled using incident density sampling, 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 significantly associated with higher risk of ESKD (OR 6.2 [1.6, 23.8]) adjusted for patient demographics including hypertension, proteinuria, race and eGFR at the time of kidney biopsy. Peripheral eosinophilia had a significant linear association with tissue eosinophilia, 22 (SD 20) per high power field (hpf) in 4-10% peripheral eosinophilia, 19 (SD 18) hpf in >10% eosinophilia and 3 (SD 7) 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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Eosinophilia and Risk of Incident End Stage Kidney Disease

10.21203/rs.2.13162/v3 ◽

2020 ◽

Author(s):

Anam Tariq ◽

Keisuke Okamato ◽

Azka Tariq ◽

Avi Z. Rosenberg ◽

Karim Soliman ◽

...

Keyword(s):

Kidney Disease ◽

Kidney Biopsy ◽

Kidney Tissue ◽

Renal Diseases ◽

Peripheral Eosinophilia ◽

End Stage Kidney Disease ◽

Blood Leukocytes ◽

Tissue Eosinophilia ◽

Biopsy Tissue ◽

End Stage

Abstract 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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Eosinophilia and Risk of Incident End Stage Kidney Disease

10.21203/rs.2.13162/v2 ◽

2019 ◽

Author(s):

Anam Tariq ◽

Keisuke Okamato ◽

Azka Tariq ◽

Avi Z. Rosenberg ◽

Karim Soliman ◽

...

Keyword(s):

Kidney Disease ◽

Kidney Biopsy ◽

Kidney Tissue ◽

Renal Diseases ◽

Peripheral Eosinophilia ◽

End Stage Kidney Disease ◽

Blood Leukocytes ◽

Tissue Eosinophilia ◽

Biopsy Tissue ◽

End Stage

Abstract 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 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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Non-proteinuric rather than proteinuric renal diseases are the leading cause of end-stage kidney disease

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfw440 ◽

2017 ◽

Vol 32 (suppl_2) ◽

pp. ii194-ii199 ◽

Cited By ~ 9

Author(s):

Davide Bolignano ◽

Carmine Zoccali

Keyword(s):

Kidney Disease ◽

Renal Diseases ◽

End Stage Kidney Disease ◽

End Stage

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A massive natural disaster, the Great East Japan Earthquake, and the incidence of dialysis due to end-stage kidney disease

Journal of Nephrology ◽

10.1007/s40620-021-01140-9 ◽

2021 ◽

Author(s):

Michiaki Abe ◽

Tetsuya Akaishi ◽

Koto Ishizawa ◽

Hirohisa Shinano ◽

Hiroshi Ohtomo ◽

...

Keyword(s):

Diabetic Nephropathy ◽

Kidney Disease ◽

Renal Disease ◽

Great East Japan Earthquake ◽

Dialysis Initiation ◽

Renal Diseases ◽

City Hospital ◽

End Stage Kidney Disease ◽

Significant Difference ◽

End Stage

Abstract Background Disaster-related stress can increase blood pressure and the incidence of cardiovascular diseases. However, the role of massive disasters in the development of end-stage kidney disease (ESKD) remains unknown. We investigated the incidence and different causes of dialysis initiation in patients with chronic kidney disease in a city affected by the Great East Japan Earthquake. Methods This was a single-center, retrospective observational study. All patients who initiated or were treated with dialysis at Kesennuma City Hospital between 2007 and 2020 were enrolled. The year of dialysis initiation was retrospectively determined based on the initiation date. The causative renal diseases that led to the need for dialysis initiation were divided into four groups: diabetic nephropathy, hypertensive renal disease, glomerulonephritis, and others. Results Age at dialysis initiation differed significantly among the four groups (p = 0.0262). There was a significant difference in the numbers of the four groups before and after the Great East Japan Earthquake (p = 0.0193). The age of hypertensive renal disease patients was significantly higher than those of patients with diabetic nephropathy (p = 0.0070) and glomerulonephritis (p = 0.0386) after the disaster. The increasing number of dialysis initiations after the Great East Japan Earthquake appeared to be associated with changes in hypertensive renal diseases; the number peaked after 10 years. Conclusions There was an increase in the number of dialysis initiations, especially caused by hypertensive renal diseases, for up to 10 years after the Great East Japan Earthquake. Graphic abstract

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Kidney Disease in Pregnancy

10.2310/im.12016 ◽

2017 ◽

Author(s):

Kavitha Vellanki ◽

Susan Hou

Keyword(s):

Glomerular Filtration Rate ◽

Kidney Transplantation ◽

Kidney Disease ◽

Lupus Nephritis ◽

Serum Creatinine ◽

Filtration Rate ◽

Kidney Biopsy ◽

End Stage Kidney Disease ◽

Proliferative Lupus Nephritis ◽

End Stage

Pregnancy-induced changes in renal hemodynamics play an important role in favorable maternal and fetal outcomes. Renal plasma flow and glomerular filtration rate (GFR) increase by approximately 50% in normal pregnancy, leading to a decrease in both blood urea nitrogen and serum creatinine when compared with prepregnancy levels. Hence, serum creatinine–based formulas are not accurate in calculating estimated GFR in pregnant patients. The most compelling risk for pregnant women with moderate to severe chronic kidney disease is the risk of rapid progression of underlying kidney disease; the mechanisms for such decline are yet to be elucidated. The rule of kidney disease not progressing when serum creatinine is less than 1.4 mg/dL does not apply to women with lupus nephritis. New-onset lupus is an indication for kidney biopsy during pregnancy because diffuse proliferative lupus nephritis requires prompt treatment and first-line treatments are teratogenic. Infertility is common in women on dialysis and is usually reversed after successful kidney transplantation. Pregnancy outcomes have improved over the years with increasing intensity of hemodialysis in end-stage kidney disease patients. Pregnancy post–kidney transplantation should be planned and teratogenic medications discontinued before conception. Key words: glomerular filtration rate, proliferative lupus nephritis, serum creatinine, pregnancy post–kidney transplantation, end-stage kidney disease, infertility, kidney biopsy

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Troponins, Acute Coronary Syndrome and Renal Disease: From Acute Kidney Injury Through End-stage Kidney Disease

European Cardiology Review ◽

10.15420/ecr.2019.28.2 ◽

2019 ◽

Vol 14 (3) ◽

pp. 187-190

Author(s):

Debasish Banerjee ◽

Charlotte Perrett ◽

Anita Banerjee

Keyword(s):

Acute Kidney Injury ◽

Kidney Disease ◽

Kidney Diseases ◽

Kidney Injury ◽

Left Ventricular ◽

End Stage Kidney Disease ◽

Chronic Kidney Diseases ◽

Coronary Syndrome ◽

End Stage ◽

Cardiac Troponins

The diagnosis of acute coronary syndromes (ACS) is heavily dependent on cardiac biomarker assays, particularly cardiac troponins. ACS, particularly non-ST segment elevation MI, are more common in patients with acute kidney injury, chronic kidney disease (CKD) and end-stage kidney disease (ESKD), are associated with worse outcomes than in patients without kidney disease and are often difficult to diagnose and treat. Hence, early accurate diagnosis of ACS in kidney disease patients is important using easily available tools, such as cardiac troponins. However, the diagnostic reliability of cardiac troponins has been suboptimal in patients with kidney disease due to possible decreased clearance of troponin with acute and chronic kidney impairment and low levels of troponin secretion due to concomitant cardiac muscle injury related to left ventricular hypertrophy, inflammation and fibrosis. This article reviews the metabolism and utility of cardiac biomarkers in patients with acute and chronic kidney diseases. Cardiac troponins are small peptides that accumulate in both acute and chronic kidney diseases due to impaired excretion. Hence, troponin concentrations rise and fall with acute kidney injury and its recovery, limiting their use in the diagnosis of ACS. Troponin concentrations are chronically elevated in CKD and ESKD, are associated with poor prognosis and decrease the sensitivity and specificity for diagnosis of ACS. Yet, the evidence indicates that the use of high-sensitivity troponins can confirm or exclude a diagnosis of ACS in the emergency room in a significant proportion of kidney disease patients; those patients in whom the results are equivocal may need longer in-hospital assessment.

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