Eosinophilia in patients undergoing dialysis.

Voudiclaris, S; Kalmantis, T; Virvidakis, K; Karafoulidou, Anastasia; Papaspyrou-Zona, A

doi:10.1136/bmj.284.6311.272-e

Cited by 8 publications

(10 citation statements)

References 2 publications

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“…Eosinophilia encountered in the patients maintained on HD is generally thought to originate in a reaction caused by foreign bodies passing through the extracorpo real bypass [4,14], A considerable proportion of the present HD patients had eosinophilia, although it had no appreciable relation with prutitus or capillary changes, nor was there any evidence of eosinophilic infiltration of the subepidermal lesions.…”

Section: Discussionmentioning

confidence: 67%

Microangiopathic Changes of Subepidermal Capillaries in End-Stage Renal Failure

Ichimaru¹,

Horie

1987

Nephron

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Skin biopsies were taken from 63 patients with end-stage renal failure (ESRF) and 5 normal volunteers, 53 of whom were on maintenance hemodialysis (HD) and the other 10 without HD. They were examined with light and electron microscopy and subepidermal capillaries were subjected to image analysis. Thickening of the basement membrane (BM) with multilamination of the basal lamina, endothelial activation and chronic inflammatory cell infiltration with participation of mast cells were evident. The extent of these BM changes was correlated with the duration of HD, but not significantly correlated with the clinical findings indicative of arteriosclerosis. There was significant correlation between the duration of HD and mast cell proliferation or eosinophilia. We suspect that the subepidermal capillary changes represent an inflammatory reaction provoked by uremic toxins or by the repeated use of an artificial organ.

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Section: Discussionmentioning

confidence: 67%

Microangiopathic Changes of Subepidermal Capillaries in End-Stage Renal Failure

Ichimaru¹,

Horie

1987

Nephron

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“…Our patient may have been predisposed to an IgE mediated hypersensitivity reaction given her baseline eosinophilia prior to exposure to polysulfone (16% eosinophils on admission). Eosinophilia, however, is not uncommon in patients on hemodialysis (observed in as high as 52% of ESRD patients ) and it is unclear if this has any impact on allergic risk. The exact mechanism for this is unknown, but is thought to involve an immune reaction to components of the dialysis apparatus.…”

Section: Discussionmentioning

confidence: 94%

Anaphylactic Shock at the Beginning of Hemodialysis

Sayeed

Murdakes

Spec

et al. 2015

Seminars in Dialysis

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In patients who receive hemodialysis, most hypersensitivity reactions to components of the dialysis circuit are due to ethylene oxide or complement activating bio-incompatible membranes. We present a case of a 59 year-old female, with a 4-year history of uneventful hemodialysis using a cellulose based dialyzer membrane at her outpatient dialysis center, who developed repeated anaphylactic reactions associated with markers of an IgE mediated hypersensitivity reaction when a polysulfone based dialyzer membrane was used while she was hospitalized. Only when the patient's dialyzer was changed back to her usual cellulose based membrane, did these reactions cease. On the basis of her clinical course and laboratory findings, we concluded that the patient's symptoms were due to exposure to polysulfone. This case reminds us that "biocompatible" membranes are not free from dialyzer reactions, and can be especially severe if the mechanism is an IgE mediated anaphylactic hypersensitivity reaction.

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“…It has been reported that the prevalence of eosinophilia in hemodialysis patients is 13% to 52%. [ 4 , 5 ] Dialyzer membrane materials have been considered to be the principal cause of eosinophilia in hemodialysis patients, [ 6 , 7 ] and in the present cases, the dialyzer membrane was changed from polysulfone to cellulose triacetate. However, this did not ameliorate the eosinophilia.…”

Section: Discussionmentioning

confidence: 96%

Idiopathic hypereosinophilic syndrome in hemodialysis patients

Mutsuyoshi

Hirai²,

Morino³

et al. 2021

Medicine

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Rationale: Herein, we report 3 hemodialysis patients with idiopathic hypereosinophilic syndrome who were successfully treated using corticosteroid therapy. Patient concerns: Case 1 was a 63-year-old man who was undergoing hemodialysis because of bilateral nephrectomy and developed hypereosinophilia with digestive symptoms, myocardial injury, and intradialytic hypotension. Case 2 was an 83-year-old man who was undergoing hemodialysis because of nephrosclerosis and developed hypereosinophilia with pruritus, myocardial injury, and intradialytic hypotension. Case 3 was a 59-year-old man who was undergoing hemodialysis because of diabetic nephropathy and developed hypereosinophilia with pruritus, myocardial injury, and intradialytic hypotension. Diagnoses: All 3 patients presented with hypereosinophilia (eosinophil count ≥1500 /μL for more than 1 month) and multiple-organ involvement (intradialytic hypotension, cardiac injury, digestive symptoms, and allergic dermatitis). A specific cause for the hypereosinophilia was not identified by systemic computed tomography, electrocardiography, echocardiography, bone marrow examination, or blood tests. Furthermore, Case 2 and 3 had not recently started taking any new drugs and drug-induced lymphocyte stimulation tests were negative in Case 1. Therefore, they were diagnosed with idiopathic hypereosinophilic syndrome. Interventions: All 3 patients received corticosteroid therapy with prednisolone at a dose of 40 mg/d, 30 mg/d, and 60 mg/d in Case 1, 2, and 3, respectively. Outcomes: Their digestive symptoms, pruritus, intradialytic hypotension, and serum troponin I concentrations were immediately improved alongside reductions in their eosinophil counts. Lessons: There have been few case reports of idiopathic hypereosinophilic syndrome in patients undergoing hemodialysis. We believe that recording of the clinical findings and treatments of such patients is mandatory to establish the optimal management of idiopathic hypereosinophilic syndrome.

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Eosinophilia in patients undergoing dialysis.

Cited by 8 publications

References 2 publications

Microangiopathic Changes of Subepidermal Capillaries in End-Stage Renal Failure

Microangiopathic Changes of Subepidermal Capillaries in End-Stage Renal Failure

Anaphylactic Shock at the Beginning of Hemodialysis

Idiopathic hypereosinophilic syndrome in hemodialysis patients

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