Renal lesions in the obliterative cardiomyopathies: Endomyocardial fibrosis and Loffler's endocarditis

Abstract

Electron and, or light microscopic examination of paraffin embedded renal tissue obtained from necropsies on eleven patients with obliterative cardiomyopathy showed a variety of abnormalities. Glomerular lesions present in patients with endomyocardial fibrosis included capillary wall thickening, basement membrane duplication, mesangial expansion and interposition, intraluminal fibrin and dense subendothelial deposits. These changes, some of which have been reported earlier in patients with Loffler's endocarditis, probably result from deposition and organisation of immune complexes.

Immunotactoid Glomerulopathy Associated with Idiopathic Hypereosinophilic Syndrome

“…The association of these two conditions may be incidental, but the renal lesion may be a secondary immunologic consequence of the tissue damage by eosinophil cytotoxicity. This is supported by reports of a few but definite cases showing immune complex deposition in the kidney in IHES patients [8]. Further study will be required to determine the mechanisms responsible for this association.…”

“…Among them, 20% (12/ 57) have at least some renal involvement including pyuria, hematuria, modest proteinuria, and cylinduria. The previously reported renal changes in IHES include: GBM thickening [2,3,8], proliferative GN including membranoproliferative GN and acute GN [2,3], mesangial expansion and hypercellularity [1,8], glomerular and vascular fibrin deposits or thrombi [1,3,8], focal interstitial fibrosis and eosinophilic infiltration [2,3,8], thickened tubular BM [2], nephrosclerosis [1,2], and multiple renal infarcts [2]. These changes had occurred as isolated findings or in various combinations.…”

Renal involvement in idiopathic hypereosinophic syndrome

“…The prevalence of renal involvement varies from 7 [ 12 ] to 36% [ 1 ]. A review of case reports in the medical literature identifies four kidney-defined disorders related to idiopathic HES: parenchymal diseases, vascular disorders, electrolyte disturbances and Charcot–Leyden crystals (Table 3 ) [ 13 – 32 ].…”

“…About 20% of idiopathic HES patients developed proteinuria and hypertension [ 1 , 8 , 13 , 36 ] Renal insufficiency is common as a preterminal event [ 1 ] and some authors reported on dialysis treatment in patients with idiopathic HES [ 37 ].…”

Thrombotic microangiopathy associated with the hypereosinophilic syndrome

“…One report noted that as many as one in five HES patients develops proteinuria and hypertension [8]. However, most such patients present late in the course of the HES and likely have ischemic renal changes secondary to thromboembolism from endomyocardial disease [3,[7][8][9]]. Another cause of renal disease associated with increased blood eosinophils is atheroembolism [10].…”