Nephrol Dial Transplant (2004) 19: 1333
Nephrol Dial Transplant Vol. 19 No. 5 © ERA-EDTA 2004; all rights reserved
Letter
Eosinophiluria in Churg–Strauss syndrome
Sir,The original report by Churg and Strauss [1] and a subsequent report [2] commented that haematuria and proteinuria were common findings in renal involvement in Churg–Strauss syndrome (CSS). However, analysis of urinary sediment was not highlighted. Here, we report a patient with CSS who presented with eosinophils in urinary sediment.
The patient was a 54-year-old woman with a 1 year history of bronchial asthma. Two months before admission, she developed numbness of her left hand and, subsequently, numbness developed in both legs. Because of complications of mild pyrexia and weight loss, the patient was admitted. Laboratory findings showed leukocytosis (18 100/µl) and eosinophilia (46.5% of peripheral leukocytes). Levels of serum IgE (2116 IU/l), C-reactive protein (6.28 mg/dl), rheumatoid factor (78.0 IU/ml) and MPO-ANCA (151 EU) were also elevated. Values for serum creatinine (0.53 mg/l) and creatinine clearance (88.2 ml/min) were within normal range. Although the excretion of urinary protein was mild (1.16 g/day), findings from examination of urinary sediment were multifactorial. Specifically, a large number of red blood cells (RBCs) [>100/high power field (HF)] and white blood cells (WBCs) (30–50/HF) were observed together with hyaline (1–4/HF), granular (0–1/low power field), RBC and WBC casts. Renal histology showed (Figure 1a): (i) tubulointerstitial nephritis with massive infiltration of eosinophils; (ii) vasculitis involving small- and medium-sized vessels; (iii) segmental proliferative glomerulonephritis with cellular crescents; and (iv) some tubules obstructed by casts consisting of eosinophils. Based on the clinical and pathological findings that are defined in the American College of Rheumatology (1990) traditional classification criteria [3], the patient was diagnosed as having CSS. The collected urinary sediment was evaluated by light microscopy using May Grünwald–Giemsa stain (Figure 1b). Surprisingly, 49% of WBCs had eosinophilic granules in their cytoplasm. After initiation of corticosteroid therapy (50 mg/day predonisolone p.o. with tapering), her symptoms gradually disappeared, with the exception of numbness. After 6 weeks, proteinuria was reduced (0.3 g/day) and the urinary sediment presented a nearly normal profile (RBCs: 5–9/HF; WBCs: 1–4/HF).
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Up to the present, eosinophiluria has been chiefly thought to be a sign of acute allergic interstitial nephritis, acute pyelonephritis, acute prostatitis and rapidly progressive glomerulonephritis [4]. In our case, a large number of eosinophils were detected in her urinary sediment. Although we could not clarify the origin of the urinary eosinophils, that is whether they were from damaged glomeruli and/or interstitium, these findings might parallel the occurrence of eosinophils in bronchoalveolar lavage in respiratory involvement. Thus, we conclude that the eosinophiluria presumably indicated renal damage in CSS.
Conflict of interest statement. None declared.
1Internal Medicine II Nihon University School of Medicine 2Department of Clinical Laboratory Nihon University Itabashi Hospital Tokyo, Japan Email: iohsawa{at}med.nihon-u.ac.jp.
References
- Churg J, Strauss L. Allergic granulomatosis, allergic angiitis, and periarteritis nodosa. Am J Pathol 1951; 27: 277–301[Web of Science][Medline]
- Clutterbuck EJ, Evans DJ, Pusey CD. Renal involvement in Churg–Strauss syndrome. Nephrol Dial Transplant 1990; 5: 161–167
[Abstract/Free Full Text] - Masi AT, Hunder GG, Lie JT et al. The American College of Rheumatology 1990 criteria for the classification of Churg–Strauss syndrome (allergic granulomatosis and angiitis). Arthritis Rheum 1990; 33: 1094–1100[Web of Science][Medline]
- Nolan CR, Anger MS, Kelleher SP. Eosinophiluria. A new method of detection and definition of the clinical spectrum. N Engl J Med 1986; 315: 1516–1519[Abstract]
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