Journal article
Interstitial eosinophilic aggregates in diabetic nephropathy: allergy or not?
Nephrology, dialysis, transplantation, Vol.30(8), pp.1370-1376
08/2015
DOI: 10.1093/ndt/gfv067
PMID: 25813275
Abstract
Interstitial eosinophilic aggregates (IEA) in renal biopsies often suggest allergic tubulointerstitial nephritis, yet clear associations with drug reactions are often difficult to establish. IEA are also encountered in diabetic nephropathy (DN) and thought to be attributed to medication exposure.
Native medical kidney biopsies performed at the University of Washington Medical Center were reviewed, including DN (n = 64), IgA nephropathy (IgAN, n = 28), membranous nephropathy (MN, n = 14), focal and segmental glomerulosclerosis (FSGS, n = 27) and membranoproliferative glomerulonephritis (MPGN, n = 28). IEA were defined as ≥5 eosinophils per high power field. The severity of interstitial fibrosis and tubular atrophy (IFTA) was scored semi-quantitatively as minimal, mild, moderate or severe.
IEA were remarkably more prevalent in DN (41%), when compared with IgAN (7%, P = 0.001), MN (8%, P = 0.017) or MPGN (14%, P = 0.013), but not FSGS (26%, P = 0.18). In DN cases, univariate analysis revealed that IEA were associated with greater IFTA severity, but not with the percentage of glomerulosclerosis, mesangial expansion, history of drug allergy, number of prescribed medications or particular class of medications (antibiotics, NSAIDs, aspirin, thiazide, loop diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, beta blockers, insulin, sulfonylurea, metformin or allopurinol). Multivariate analysis showed that the severity of IFTA was the only significant predictor for IEA (P < 0.01) after stepwise adjustment for age, number of medications, drug allergy, diabetes type, % global glomerulosclerosis and mesangial expansion.
Our study shows that IEA are more common in DN, when compared with other types of glomerulopathy. In DN, IEA are associated with the severity of IFTA but not with prescribed medications or clinical history of allergy. This suggests that in DN IEA are often associated with chronic tubulointerstitial injury and are not diagnostic of an allergic interstitial nephritis.
Details
- Title: Subtitle
- Interstitial eosinophilic aggregates in diabetic nephropathy: allergy or not?
- Creators
- Dao-Fu Dai - Department of Pathology, University of Washington Medical Center, Seattle, WA, USAKotaro Sasaki - Department of Pathology, University of Washington Medical Center, Seattle, WA, USAMercury Y Lin - Department of Pathology, University of Washington Medical Center, Seattle, WA, USAKelly D Smith - Department of Pathology, University of Washington Medical Center, Seattle, WA, USARoberto F Nicosia - Department of Pathology, University of Washington Medical Center, Seattle, WA, USA Pathology and Laboratory Medicine Services, VA Puget Sound Health Care System, Seattle, WA, USACharles E Alpers - Department of Pathology, University of Washington Medical Center, Seattle, WA, USABehzad Najafian - Department of Pathology, University of Washington Medical Center, Seattle, WA, USA
- Resource Type
- Journal article
- Publication Details
- Nephrology, dialysis, transplantation, Vol.30(8), pp.1370-1376
- Publisher
- England
- DOI
- 10.1093/ndt/gfv067
- PMID
- 25813275
- ISSN
- 0931-0509
- eISSN
- 1460-2385
- Language
- English
- Date published
- 08/2015
- Academic Unit
- Pathology; Iowa Neuroscience Institute; Radiation Oncology
- Record Identifier
- 9984047679002771
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