Eosinophiluria — A New Method of Detection and Definition of the Clinical Spectrum

Abstract

Eosinophiluria is considered a useful marker of drug-induced acute interstitial nephritis. However, recognition of eosinophiluria by Wright's staining is technically difficult, and the spectrum of disorders causing eosinophiluria is not completely defined. We have adapted Hansel's stain for the examination of urinary sediment. Whereas there was a variable uptake of Wright's stain by eosinophils in the urine, such eosinophils were readily recognized with Hansel's stain by the presence of bright red granules. The prevalence of eosinophiluria in acute interstitial nephritis was 10 of 11 patients, in acute tubular necrosis none of 30, in acute pyelonephritis none of 10, in acute cystitis 1 of 15, in postinfectious glomerulonephritis 1 of 6, in rapidly progressive glomerulonephritis 4 of 10, and in acute prostatitis 6 of 10. Eosinophiluria in acute interstitial nephritis was demonstrated by Hansel's stain in 10 of 11 patients but by Wright's stain in only 2 of 11 patients. We conclude that Hansel's stain substantially improves the recognition of eosinophiluria as compared with Wright's stain. Eosinophiluria is useful in distinguishing acute interstitial nephritis from acute tubular necrosis. The clinical spectrum of eosinophiluria also includes rapidly progressive glomerulonephritis, acute prostatitis, and occasionally, acute cystitis or postinfectious glomerulonephritis.

Tetracycline-Induced Acute Interstitial Nephritis as a Cause of Acute Renal Failure

“…Eosinophiluria tends to support the diagnosis of allergic, drug-induced AIN and is best documented with Hansel’s stain [15], although its absence should never be used to exclude the diagnosis of AIN [7, 12]. Recently, Ruffing et al [16]reported that eosinophiluria as an indicator of AIN has the sensitivity of 40% and the specificity of 72% with a positive predictive value of only 38%, revealing that it is not actually an accurate test for diagnosis of AIN.…”

Renal Amyloidosis Associated with Antiglomerular Basement Membrane Disease

“…Several mechanisms of NSAID nephrotoxicity have been described: hemodynamic acute renal failure, papillary necrosis, interstitial nephritis, nephrotic syn drome, vasculitis, hidrosaline metabolism disturban ces and hyperkalemia [6]. In our case, the anuria and eosinophiluria focused on an immunoallergic etiolo gy, although eosinophiluria is not a pathognomonic feature [7],…”

Clinical Characterization of Drug-Induced Allergic Nephritis

“…67Ga scintigram was performed by gammacamera scanner (Hitachi Co., Tokyo) 24-72 h after injecting 2 mCi 67Ga per 50 kg body weight. Eosinocytes in the urine were examined using Hansel's staining method [7], especially at the early stage of onset. Immunological examinations consisted of determining serum CH50, circulating imune complexes and LST which was evaluated by the incorporation of }H-thymidine into the peripheral lympho cytes.…”