Disease characteristics of 70 patients with Kimura disease

Disease characteristics of 70 patients with Kimura disease | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Disease characteristics of 70 patients with Kimura disease Wenhui Zhang, Yaling Zhai, Huijuan Tian, Shuaigang Sun This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2166793/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To analyze the disease characteristics of patients with Kimura disease (KD) and provide reference for clinical practice. Methods Laboratory data of 70 patients with KD diagnosed based on pathology at the First Affiliated Hospital of Zhengzhou University from August 2012 to December 2021 were collected. Clinical manifestations, renal involvement, treatments, and risk factors for recurrence were analyzed. Results Among the 70 patients, 61 were male and 9 were female; 61.4% of patients (43/70) had focal masses only in the head and neck region and 30.0% (21/70) had masses not restricted to the head and neck; 52.9% (37/70) had pruritus. The proportion of eosinophils in peripheral blood was elevated in 80.0% of patients (56/70), and the level of serum immunoglobulin (Ig)E was increased in 96% (24/25). Renal damage was a complication in 21.8% of patients (12/55). Serum albumin and total protein levels were significantly lower in patients with as compared to those without renal impairment. Of the 70 patients, 37 had disease recurrence following treatment (surgical resection, oral corticosteroids, immunosuppressants, radiotherapy, or combinations thereof). Risk factors for KD recurrence were percentage of eosinophils in peripheral blood ≥ 20%, maximum diameter of masses ≥ 3 cm, and masses at multiple sites ( p < 0.05). Conclusion KD is a systemic disease involving multiple organs, especially the kidney. A better understanding of disease pathogenesis can lead to the development of effective treatments that improve the prognosis of patients. Kimura disease Eosinophilic hyperplastic lymphogranuloma Nephrotic syndrome Figures Figure 1 Introduction Kimura disease (KD) is a benign chronic inflammatory disorder that usually presents as a painless subcutaneous mass in the head and neck region in young Asian males, and is often accompanied by peripheral eosinophilia and elevated serum immunoglobulin (Ig)E. Because of its rarity and varied manifestations, KD can be difficult to distinguish from tumors and other chronic inflammatory conditions, leading to high rates of missed diagnosis and misdiagnosis. Most studies on this disease have been in the form of case reports. The current study analyzed and summarized the clinical data and characteristics of 70 patients with KD at our hospital in the past 9 years, with the aim of providing information that can be useful for clinical diagnosis and treatment. Materials And Methods Study subjects A total of 70 patients with pathologically confirmed KD were admitted to the First Affiliated Hospital of Zhengzhou University from August 2012 to December 2021. Patient data including age, sex, first consultation department, clinical manifestations, laboratory data, imaging findings, pathologic characteristics, treatment methods, and recurrence were collected. The patients were divided into renal involvement (urinary protein or glomerulogenic hematuria, or decreased glomerular filtration rate, etc) and non-renal involvement groups, which were compared in terms of general condition, clinical manifestations, and laboratory test results. Statistical analysis All statistical analyses were performed using SPSS software v26.0 (IBM, Armonk, NY, USA). Continuous variables are expressed as mean ± standard deviation or median with interquartile range and were analyzed with the unpaired t test or nonparametric Mann–Whitney U test as appropriate for normally and non-normally distributed variables. Categorical data were analyzed with the chi-squared test or Fisher’s exact test, and are presented as frequency (percentage). Logistic regression was used to analyze risk factors for disease recurrence. p < 0.05 was considered statistically significant. Results Clinicopathologic features A total of 70 patients with KD were enrolled in the study and followed up for 6 months to 10 years. The first diagnosis department in order of decreasing frequency was stomatology (32%), oncology (24%), otolaryngology head and neck surgery (14%), ophthalmology (6%), nephrology (4%), hematology (4%), and rheumatology (3%); the remaining patients were admitted from the rhinology, dermatology, orthopedics, neurosurgery, and respiratory departments (13%) (Fig. 1 ). Of the 70 patients, 61 (87.1%) were male and 9 (12.9%) were female. The age of onset ranged from 7 to 77 years, and 32 patients (45.7%) developed the disease between the age of 20 and 40 years. There were 64 patients (91.4%) who presented with subcutaneous masses in the head and neck region, mostly involving local salivary or parotid glands; 21 of these cases (32.8%) had lymphadenopathy in the axilla and groin, 4 (6.3%) presented with orbital masses, 1 (1.6%) had frontal masses, and 1 (1/64, 1.6%) had temporal masses. Six of the 70 patients (8.6%) had tumors only in the axilla, groin, upper arm, or other parts of the head and neck and 40 (57.1%) had masses > 3 cm in diameter; 37 (52.9%) had associated pruritus symptoms, 56 (80.0%) had peripheral blood eosinophilia, and 36 (51.4%) had a proportion of eosinophils > 20%. Recurrence rate was higher in patients with multisite disease, mass maximum diameter ≥ 3 cm, and peripheral blood eosinophil percentage ≥ 20% ( p < 0.05; Table 1 ). Of the 18 patients who underwent bone puncture, 15 had elevated eosinophils in bone marrow. Elevated serum IgE levels were observed in 24/25 cases (96.0%). All 21 patients who were tested for C-reactive protein had normal levels. Lymphatic tissue hyperplasia was observed in all surgical specimens, accompanied by reactive germinal centers, eosinophil infiltration, and occasional eosinophilic microabscess. Immunohistochemistry was performed in 36 patients; 35 (97.2%) were positive for cluster of differentiation (CD)20, 34 (94.4%) for CD3, 29 (80.6%) for CD21, 14 (38.9%) for CD30, and 11 (30.6%) for CD1a. Additionally, 15 patients (41.7%) were positive for B cell lymphoma (Bcl)-2, 10 (27.8%) for Bcl-6, and 1 (2.8%) for cytokeratin AE1/AE3. Ki-67 was expressed to varying degrees in all patients. Analysis of disease characteristics of KD patients with renal impairment Routine urine and renal function at diagnosis were available for 55 patients. Renal involvement was observed in 12 patients (12/55, 21.8%); 8 were treated with oral corticosteroids alone or combined with immunosuppressants and achieved complete remission. One patient had a 6-month history of renal impairment and was treated with rituximab without achieving remission. One patient had reduced renal function and underwent renal transplantation for a subcutaneous mass; 2 patients underwent only surgical resection of the subcutaneous tumor, and gradually became negative for urine proteins. Three patients underwent renal biopsy, and the pathologic finding was minimal change glomerulopathy without (2 patients) or with (1 patient) mild mesangial proliferative IgA nephropathy. The latter patient had renal interstitium with small focal scattered eosinophil infiltrates (Table 2 ). Serum albumin and total protein levels were significantly lower in patients with vs. those without renal impairment ( p < 0.05); there were no significant differences in age; sex ratio; pruritus; disease location; hemoglobin; neutrophil, lymphocyte, eosinophil, and basophil counts; blood lipids; serum creatinine; and uric acid between groups (Table 3 ). Treatment methods and recurrence According to previous studies, an increase in tumor diameter or the presence of a new mass was considered as recurrence [ 1 ] in this study. The recurrence rate was 68.4% with surgical resection, 83.3% with oral corticosteroids, 33.3% with surgical resection + oral corticosteroids or oral corticosteroids + immunosuppressants, 25.0% with surgical resection + oral corticosteroids + immunosuppressant, and 0% with surgical resection + radiotherapy (Table 4 ). A total of 37/70 patients (52.9%) relapsed after treatment; of these, 10 received no further treatment, 11 underwent surgical resection, 6 were treated with oral corticosteroids and/or immunosuppressants, 3 underwent surgical resection and received oral corticosteroids and/or immunosuppressants, 3 received radiotherapy, 2 patients were treated with etanercept, 1 underwent surgical resection and received radiotherapy combined with tegafur, and 1 was treated with omalizumab. Risk factors for KD recurrence According to the results of a univariate analysis, peripheral blood eosinophil percentage ≥ 20%, maximum diameter of mass ≥ 3 cm, and multisite disease were included in the multivariate logistic regression model along with age and sex to identify risk factors for KD recurrence. The results showed that peripheral blood eosinophil percentage ≥ 20%, maximum diameter of mass ≥ 3 cm, and multisite disease were significant risk factors ( p < 0.05; Table 5 ). Table 1 General and recurrent conditions of 70 patients Clinical characteristics No. of patients No. of recurrent patients χ 2 p value Sex — 0.290 Male 61 (87.1) 34 (55.7) Female 9 (12.9) 3 (33.3) Age, years 0.063 0.969 40 24 (34.3) 13 (64.2) Anatomical location — 0.005 Head and neck 43 (61.4) 17 (39.5) Other parts of the head and neck 6 (8.6) 3 (50.0) Head and neck and other parts 21 (30.0) 17 (80.9) Mass size 5.523 0.019 < 3 cm 30 (42.9) 11 (36.7) ≥ 3 cm 40 (57.1) 26 (65.0) Pruritus 2.727 0.099 Yes 37 (52.9) 23 (62.2) No 33 (47.1) 14 (42.4) Allergic history — 0.462 Yes 8 (11.4) 3 (37.5) No 62 (88.6) 34 (54.8) Hypertension — 0.411 Yes 6 (8.6) 2 (33.3) No 64 (91.4) 35 (54.7) Diabetes — 1.000 Yes 4 (5.7) 2 (50.0) No 66 (94.3) 35 (53.0) Smoking 0.986 0.321 Yes 21 (30.0) 13 (61.9) No 49 (70.0) 24 (48.9) Alcohol drinking 2.850 0.091 Yes 12 (17.1) 9 (75.0) No 58 (82.9) 28 (48.3) Renal impairment 2.215 0.137 Yes 12 (17.1) 4 (33.3) No 58 (82.9) 33 (56.9) Percentage of eosinophils 5.672 0.017 < 20% 34 (48.6) 13 (38.2) ≥ 20% 36 (51.4) 24 (66.7) Data are presented as n (%). —, Using Fisher’s exact probability method. Table 2 Clinicopathologic features of 12 cases of Kimura disease with comorbid renal impairment Patient no. Age, years Sex Serum IgE, IU/ml Eo% Creatinine, µmol/l eGFR, min·1.73 m 2 Albumin, g/l Total protein, g/l Urine protein Urinary red blood cells, /ml 24-h Urine protein, g Renal pathology type Bone puncture Treatment 1 30 M 426 9.5 81 103.1 44.2 67.1 − 13 NA NA No Surgical excision + oral corticosteroids 2 18 F 1997 3.5 75 92.8 20.1 40.5 ++++ 30 NA MCD No Surgical excision + rituximab 3 22 M NA 18.7 56 124.8 43.9 64.8 − 8 NA NA No Surgical excision + oral corticosteroids 4 40 M NA 22.6 73 109.7 44 67.7 ± 6 NA NA Yes Oral corticosteroid + cyclophosphamide 5 62 F NA 48.9 44 133.6 22.1 67.6 − 0 0.34 NA No Surgical excision + leflunomide 6 22 M 1423 48.9 100 86.1 45.6 70.8 ± 1 NA NA Yes Surgical excision + radiotherapy 7 21 M 743 16.0 193 40.7 17.4 37.9 ++++ 0 12.76 MCD No Surgical excision + tacrolimus 8 44 M NA 21.6 826 6.5 34.7 58.4 ± 0 1.09 NA No Surgical excision + renal transplantation 9 59 M NA 30.8 104 67.4 38.2 59.6 + 1 NA NA No Surgical excision 10 52 M NA 24.2 51 67.4 35 62.9 ± 0 NA NA No Surgical excision 11 26 M > 2500 44.6 70 125.7 13 42.2 +++ 0 11.59 MCD with IgAN Yes Surgical excision + oral corticosteroids + MMF 12 63 M NA 25.1 58 130.5 41.1 64.2 ± NA NA NA No Surgical excision + oral corticosteroids eGFR, estimated glomerular filtration rate; Eo%, proportion of peripheral blood eosinophils; F, female; IgAN, mild mesangial proliferative IgA nephropathy; IgE, immunoglobulin E; M, male; MCD, minimal change disease; MMF, mycophenolate mofetil; NA, not available. Table 3 Clinical data of patients with or without renal impairment Clinical characteristic Without renal impairment (n = 43) With renal impairment (n = 12) Z / χ 2 / t p value Male 37 (86.0%) 10 (83.3%) — 1.000 Age 34.72 ± 16.20 38.25 ± 17.28 −0.658 0.513 Pruritus 25 (58.1%) 7 (58.3%) 0.000 0.990 Multiple site 16 (37.2%) 3 (25.0%) — 0.511 Eo% ≥20% 19 (44.2%) 8 (66.7%) 1.897 0.168 Hemoglobin, g/l 140.0 (132.95,150.80) 145.50 (102.68,156.00) −0.174 0.862 Neutrophils, 10 9 /l 3.87 (2.93,4.52) 3.23 (2.62,4.40) −1.444 0.149 Lymphocytes, 10 9 /l 2.38 (1.57,2.97) 2.08 (1.57,2.91) −0.733 0.464 Monocytes, 10 9 /l 0.52 (0.40,0.66) 0.44 (0.35,0.57) −1.677 0.093 Eosinophils, 10 9 /l 1.06 (0.41,2.67) 1.39 (0.91,2.85) −0.910 0.363 Triglycerides, mmol/l 1.19 (0.96,1.68) 1.19 (0.80,1.78) −0.328 0.743 Cholesterol, mmol/l 3.59 (3.42,4.45) 4.02 (3.44,8.17) −0.984 0.325 Creatinine, mmol/l 66.00 (59.75,79.00) 74.00 (54.75,126.25) −1.477 0.140 Uric acid, µmol/l 290.15 ± 82.59 292.83 ± 70.10 −0.102 0.919 Albumin, g/l 44.15 (42.20,46.85) 34.85 (19.43,43.93) −3.109 0.002 Total protein, g/l 69.74 ± 4.27 58.64 ± 11.67 3.277 0.007 Data are presented as n (%), mean ± SD, or median (interquartile range). —, Using Fisher’s exact probability method. Eo, proportion of peripheral blood eosinophils. Table 4 Recurrence rate in patients according to treatment Clinical management Number of treatments Number of recurrences Recurrence rate Surgical excision 38 26 68.4 Oral corticosteroids 6 5 83.3 Surgical excision + oral corticosteroids 6 2 33.3 Oral corticosteroids + immunosuppressants 6 2 33.3 Surgical excision + oral corticosteroids + immunosuppressants 8 2 25.0 Surgical excision + radiotherapy 6 0 0.0 Table 5 Multivariate logistic regression analysis of risk factors for recurrence of Kimura disease Variable β SE Wald χ 2 p value OR 95% Cl Age −0.577 0.891 0.420 0.517 0.562 0.098–3.217 Sex 0.008 0.019 0.187 0.665 1.008 0.972–1.045 Maximum diameter of mass ≥ 3 cm 1.835 0.724 6.428 0.011 6.267 1.517–25.892 Other parts of head and neck 2.522 0.804 9.843 0.002 12.450 2.576–60.162 Eo% ≥20% 1.386 0.595 5.417 0.020 3.998 1.245–12.845 Data are presented as n (%), mean ± SD, or median (interquartile range). —, Using Fisher’s exact probability method. CI, confidence interval; Eo, proportion of peripheral blood eosinophils; OR, odds ratio; SE, standard error. Discussion KD was first identified and described as eosinophilic hyperplastic lymphogranuloma in 1938 by Xianzhai Jin [ 2 ] , a Chinese medical scientist. The pathologic features were described in detail by Kimura and colleagues and the disease has since been widely known as KD [ 3 ] . Most cases of KD have been identified in Asia, mainly in young men with head and neck involvement [ 4 ] . In the present study we present data for 70 cases of KD at our hospital in the last 9 years, making this the largest single-center study of KD to date. The male-to-female ratio was about 6.8:1, with 45.7% of patients between 20 and 40 years old and 91.4% having head and neck masses. The lesions mainly involved salivary glands, the preauricular area, and cervical lymph nodes, which is consistent with the literature [ 5 ] . The etiology of the disease remains unclear and may be related to immune system dysfunction, viral or parasitic infection, or allergic reaction [ 6 ] . Viruses and parasites can alter T cell-mediated immune regulation or induce IgE-mediated type 1 hypersensitivity, leading to the release of eosinophil factors such as interleukin (IL)-4 and IL-5 [ 7 ] ; thus, most patients with KD show peripheral blood eosinophilia and elevated blood IgE levels. In our study, 80% of patients had increased eosinophil counts in peripheral blood, 96.0% of the 25 patients who were tested had elevated IgE levels, and 83.3% of the 18 patients who underwent bone marrow aspiration had elevated bone marrow eosinophils. Additionally, 52.9% of patients had itchy skin as a symptom, possibly due to nerve infiltration of lymphocytes and eosinophils [ 8 ] . In terms of pathologic manifestations, cell proliferation in lymphoid tissue with reactive germinal centers and massive eosinophil infiltration were observed in the surgically resected specimens of all patients in this study; in some cases, well-formed lymphoid follicles were observed and occasionally, eosinophilic microabscesses. Immunohistochemical analysis revealed CD20, CD21, and CD3 positivity in most patients and CD30, CD1a, Bcl-2, and Bcl-6 positivity in some. AE1/AE3 expression was rare, and Ki-67 was expressed to varying degrees in all specimens. KD is a systemic disease that affects internal organs along with the skin and lymph nodes, causing elevated levels of eosinophils and IgE in peripheral blood. In our study, 1 patient underwent gastrointestinal endoscopy for gastrointestinal symptoms that were suggestive of eosinophilic gastroenteritis. In 1 patient, the proportion of eosinophils was 64.2% in peripheral blood and 46.8% in bone marrow; the lesion involved the right iliac vessels and ureters, and the patient ultimately developed respiratory failure, suggesting pulmonary infiltration of eosinophils. KD has a high rate of renal involvement (nephrotic syndrome). An earlier study showed that 12–16% of KD patients developed proteinuria [ 9 ] , of which 60–78% presented with nephrotic syndrome. In our study, 21.8% of patients had renal impairment, which is slightly higher than previously reported and may be attributable to the growing awareness among clinicians of KD and its impact on the kidney. The pathologic manifestations of KD-related nephropathy vary; according to one report [ 10 ] , of 2 patients with KD and nephrotic syndrome, 1 presented pathologically with focal glomerulosclerosis and another with chronic tubulointerstitial nephritis with mesangial proliferative glomerulopathy and focal segmental glomerulosclerosis. Both patients received oral corticosteroids therapy, but the latter progressed to end-stage renal disease as a result of self-discontinuation. In our study, renal puncture was performed in 3 patients and the pathologic finding was minimal change disease, including 1 patient who also had IgA nephropathy and small focal scattered eosinophil infiltrates in the renal interstitium [ 11 ] , which may be a typical change resulting from eosinophil invasion. Four patients (cases 3, 5, 8, and 12) developed nephrotic syndrome before the diagnosis of KD, and case 8 underwent renal transplantation for renal failure. A total of 8 patients were treated with oral corticosteroids alone or combined with immunosuppressants such as tacrolimus, resulting in total relief of nephrotic syndrome in all cases. Two patients also gradually became negative for urine proteins after surgical resection of the lesion. Both glucocorticoids and immunosuppressive agents are effective in the treatment of KD and nephrotic syndrome, which may reflect a similarity in the immunopathogenesis of these diseases [ 12 ] . Glucocorticoids are known to regulate lymphopoiesis and T cell proliferation, suggesting that defects in T cell immune regulation play a role in the their pathogenesis [ 13 ] ; cytokines released by activated T cells may increase the permeability of the glomerular basement membrane, leading to proteinuria [ 14 , 15 ] . We compared clinical data of patients with vs. without renal impairment, and found that the former had lower albumin and total protein levels although there were no differences in their clinical manifestations, eosinophil ratio, creatinine, etc. A recent study [ 16 ] compared the clinical data of 18 KD patients with and 31 without renal impairment but did not find significant differences in laboratory parameters, clinical manifestations, or medical history between the 2 groups. Thus, the mechanism of renal impairment in KD requires further investigation. There is still no consensus on the treatment of KD. In our cohort, 38 patients underwent surgical resection; 68.4% subsequently had tumor recurrence at the original or other sites and 8 of the patients underwent a second operation. One patient had 3 operations to remove elbow, neck, and groin masses at another hospital before visiting ours, followed by oral prednisone and leflunomide; however, when the drug treatment was tapered to discontinuation, the patient again developed neck masses. The high recurrence rate in KD may be related to the fact that lesions mostly involve nerves and poorly demarcated subcutaneous tissues, and it is difficult to obtain negative margins by surgical resection. The combination of surgery and postoperative intervention can reduce the recurrence rate of the disease. Oral corticosteroids and immunosuppressants may be effective in the treatment of KD, and long-term maintenance therapy could prevent recurrence, although patients are prone to recurrence after drug withdrawal [ 17 , 18 ] . In the present study, 6 patients were treated with a single cycle of corticosteroid therapy and 5 experienced recurrence, which presented as a new mass or increased diameter of the original tumor. Of the 6 patients treated with corticosteroids combined with cyclophosphamide, cyclosporine, and other immunosuppressive agents, 2 showed recurrence; the recurrence rate was the same as for surgery combined with corticosteroids, but was reduced to 25% when surgery was combined with both corticosteroids and immunosuppressive agents. Therefore, immunotherapy can be considered for patients with KD involving internal organs such as kidney or those with multiple lesions [ 17 , 18 ] . Six of our patients were initially treated with surgery combined with radiotherapy to control the disease, and none have experienced recurrence, so low-dose radiotherapy is an option for patients with a wide range of lesions, difficulty in complete resection, or a high risk of recurrence [ 21 , 22 ] . However, radiotherapy can cause serious side effects, which can increase patients’ concerns regarding long-term treatment. Given that KD is an essentially benign disease, it is important to carefully weigh the advantages and disadvantages of this treatment modality before it is administered to patients. Possible risk factors for KD recurrence include peripheral blood eosinophil counts and IgE levels, lesion size and duration, and whether the lesion boundary is clear [ 23 – 25 ] . Our study of 70 patients showed that lesion diameter > 3 cm, proportion of eosinophils in peripheral blood > 20%, and multisite disease significantly increased the risk of recurrence. Whether it is possible to predict KD recurrence based on peripheral blood eosinophil and IgE levels, which could guide treatment, will be the focus of future research. In conclusion, this study summarized and analyzed the clinical manifestations, pathologic features, renal damage, treatment methods, and recurrence rate of KD—a very rare inflammatory disease—in 70 patients at our hospital over the last 9 years in order to provide a reference for clinicians to recognize and treat this disease. Although KD is benign, it can affect multiple organ systems and recurrence is common. Combination therapy was superior to surgery alone in relieving symptoms. In patients with painless tumors in the head and neck, if peripheral blood eosinophils and IgE are significantly increased, a diagnosis of KD should be considered. Timely examination to identify the organs involved and implementation of active treatment are critical for reducing the risk of recurrence and improve prognosis. Declarations Acknowledgements Not applicable. Authors’ contributions WHZ was responsible for manuscript writing and statistical analysis; HJT was responsible for collection of clinical data; SGS was responsible for patients’ clinical follow-up; YLZ was responsible for the research design. The author(s) read and approved the final manuscript. FUNDING This work was supported by the National Natural Science Foundation of China (grant numbers 81600555), the China Postdoctoral Science Foundation (grant number 2018M640684). Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Ethics approval and consent to participate The study was approved by the Institutional Ethics Committee of The First Affiliated Hospital of Zhengzhou University, and conforms to the ethical guidelines of the Declaration of Helsinki. Requirement for individual patient consent forms was waived due to the retrospective, observational nature of the study. Consent for publication Not applicable. Competing interests The authors report no competing of interests. Author details 1The First Affiliated Hospital of Zhengzhou University, Department of Nephrology,Zhengzhou 450052 References Kottler D, Barete S, Quereux G, et al. Retrospective Multicentric Study of 25 Kimura Disease Patients: Emphasis on Therapeutics and Shared Features with Cutaneous IgG4-Related Disease[J]. Dermatology. 2015;231(4):367–77. DOI: 10.1159/000439346 . Kim HT. Eosinophilic hyperplastic lymphogranuloma, comparison with Mikulicz's disease[J]. Chin Med J. 1937;23:670–99. Kimura T. On the unusual granulations combined with hyperplastic changes of lymphatic tissue[J]. Trans Soc Pathol Jpn. 1948;37:179–80. Sun GC, Liu F, Sun Y, et al. [Clinical analysis of 37 cases of Kimura's disease][J]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi, 201832(10):782–786.DOI: 10.13201/j.issn.1001-1781.2018.10.014 . Zhang X, Jiao Y. 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DOI: 10.1016/j.jaip.2021.02.049 . Shah K, Tran AN, Magro CM, et al. Treatment of Kimura disease with mycophenolate mofetil monotherapy[J]. JAAD Case Rep. 2017;3(5):416–9. DOI: 10.1016/j.jdcr.2017.04.010 . Fionda B, Loperfido A, Bussu F, et al. The role of radiotherapy in Kimura's disease: a multicenter systematic review of literature[J]. Eur Rev Med Pharmacol Sci. 2021;25(12):4205–10. DOI: 10.26355/eurrev_202106_26124 . Nonaka M, Sakitani E, Yoshihara T. Anti-IgE therapy to Kimura's disease: a pilot study[J]. Auris Nasus Larynx. 2014;41(4):384–8. DOI: 10.1016/j.anl.2013.12.006 . Lin YY, Jung SM, Ko SF, et al. Kimura's disease: clinical and imaging parameters for the prediction of disease recurrence[J]. Clin Imaging. 2012;36(4):272–8.DOI:10.1016/j.clinimag.2011.11.002. Zhang Y, Bao H, Zhang X, et al. Kimura's disease: clinical characteristics, management and outcome of 20 cases from China[J]. Clin Exp Rheumatol. 2022;40(3):532–8. DOI: 10.55563/clinexprheumatol/lahgfo . Iwai H, Nakae K, Ikeda K, et al. Kimura disease: diagnosis and prognostic factors[J]. Otolaryngol Head Neck Surg. 2007;137(2):306–11. DOI: 10.1016/j.otohns.2007.03.027 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2166793","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":144796522,"identity":"1e5d88f6-9ddf-4b9c-8e25-9e6c5d0bfd42","order_by":0,"name":"Wenhui Zhang","email":"","orcid":"","institution":"First Affiliated Hospital of Zhengzhou University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Wenhui","middleName":"","lastName":"Zhang","suffix":""},{"id":144796523,"identity":"62b413e5-f634-416f-a42b-0ff1421e7177","order_by":1,"name":"Yaling Zhai","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABB0lEQVRIie3RsUoDMRjA8cTAuXxH1hwW+gpxaguHfZUDwS43OHZwyBm40TmiDj6D4JwjUJfDW5Uu3u6QLuIkTYqOzTkK5j8EAt+PkAShWOwvxhDSCE0BIVy92WUOlIpfEeYIkceqPRtlSg+T7/WwPkprk3NRhMX4RvYGLthoQu/rTLUdcKSx3ZT7Cb5dcQMrBjPVy6ldrmFCBMmuH/cTwgpHEgb8paleVbuGmdAJSQMkYQtr4GtHhLvLM3BdhAmwkpu0dqSrLh3Rw4Sx8ry5u/KnYP/Ip5CpRgbvMlaLB/v+kc9599S7rzyZUyobuwkQ3wHszit+9liE5/3Ip1+pHhyMxWKxf9oWUnZX9coARIcAAAAASUVORK5CYII=","orcid":"","institution":"First Affiliated Hospital of Zhengzhou University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Yaling","middleName":"","lastName":"Zhai","suffix":""},{"id":144796524,"identity":"a24263cc-d36f-45d1-8d08-a798241fda0b","order_by":2,"name":"Huijuan Tian","email":"","orcid":"","institution":"First Affiliated Hospital of Zhengzhou University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Huijuan","middleName":"","lastName":"Tian","suffix":""},{"id":144796525,"identity":"499b7731-090b-430f-8dd2-e660b2a55c21","order_by":3,"name":"Shuaigang Sun","email":"","orcid":"","institution":"First Affiliated Hospital of Zhengzhou University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Shuaigang","middleName":"","lastName":"Sun","suffix":""}],"badges":[],"createdAt":"2022-10-14 14:59:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2166793/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2166793/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":28051700,"identity":"6b3a508b-96a4-4bde-a664-2ad1559672b8","added_by":"auto","created_at":"2022-10-20 17:22:56","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":40908,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of first consultation departments for patients with KD.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-2166793/v1/e60026722caca85849727851.png"},{"id":29896690,"identity":"06bd9774-dbeb-44f7-9663-7683bcaa6fb0","added_by":"auto","created_at":"2022-12-05 12:15:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":394981,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2166793/v1/8ae0a409-07cd-4643-a0be-55dd7530663f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Disease characteristics of 70 patients with Kimura disease","fulltext":[{"header":"Introduction","content":"\u003cp\u003eKimura disease (KD) is a benign chronic inflammatory disorder that usually presents as a painless subcutaneous mass in the head and neck region in young Asian males, and is often accompanied by peripheral eosinophilia and elevated serum immunoglobulin (Ig)E. Because of its rarity and varied manifestations, KD can be difficult to distinguish from tumors and other chronic inflammatory conditions, leading to high rates of missed diagnosis and misdiagnosis. Most studies on this disease have been in the form of case reports. The current study analyzed and summarized the clinical data and characteristics of 70 patients with KD at our hospital in the past 9 years, with the aim of providing information that can be useful for clinical diagnosis and treatment.\u003c/p\u003e"},{"header":"Materials And Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy subjects\u003c/h2\u003e \u003cp\u003eA total of 70 patients with pathologically confirmed KD were admitted to the First Affiliated Hospital of Zhengzhou University from August 2012 to December 2021. Patient data including age, sex, first consultation department, clinical manifestations, laboratory data, imaging findings, pathologic characteristics, treatment methods, and recurrence were collected. The patients were divided into renal involvement (urinary protein or glomerulogenic hematuria, or decreased glomerular filtration rate, etc) and non-renal involvement groups, which were compared in terms of general condition, clinical manifestations, and laboratory test results.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eAll statistical analyses were performed using SPSS software v26.0 (IBM, Armonk, NY, USA). Continuous variables are expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation or median with interquartile range and were analyzed with the unpaired \u003cem\u003et\u003c/em\u003e test or nonparametric Mann\u0026ndash;Whitney \u003cem\u003eU\u003c/em\u003e test as appropriate for normally and non-normally distributed variables. Categorical data were analyzed with the chi-squared test or Fisher\u0026rsquo;s exact test, and are presented as frequency (percentage). Logistic regression was used to analyze risk factors for disease recurrence. \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eClinicopathologic features\u003c/h2\u003e \u003cp\u003e A total of 70 patients with KD were enrolled in the study and followed up for 6 months to 10 years. The first diagnosis department in order of decreasing frequency was stomatology (32%), oncology (24%), otolaryngology head and neck surgery (14%), ophthalmology (6%), nephrology (4%), hematology (4%), and rheumatology (3%); the remaining patients were admitted from the rhinology, dermatology, orthopedics, neurosurgery, and respiratory departments (13%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOf the 70 patients, 61 (87.1%) were male and 9 (12.9%) were female. The age of onset ranged from 7 to 77 years, and 32 patients (45.7%) developed the disease between the age of 20 and 40 years. There were 64 patients (91.4%) who presented with subcutaneous masses in the head and neck region, mostly involving local salivary or parotid glands; 21 of these cases (32.8%) had lymphadenopathy in the axilla and groin, 4 (6.3%) presented with orbital masses, 1 (1.6%) had frontal masses, and 1 (1/64, 1.6%) had temporal masses. Six of the 70 patients (8.6%) had tumors only in the axilla, groin, upper arm, or other parts of the head and neck and 40 (57.1%) had masses\u0026thinsp;\u0026gt;\u0026thinsp;3 cm in diameter; 37 (52.9%) had associated pruritus symptoms, 56 (80.0%) had peripheral blood eosinophilia, and 36 (51.4%) had a proportion of eosinophils\u0026thinsp;\u0026gt;\u0026thinsp;20%. Recurrence rate was higher in patients with multisite disease, mass maximum diameter\u0026thinsp;\u0026ge;\u0026thinsp;3 cm, and peripheral blood eosinophil percentage\u0026thinsp;\u0026ge;\u0026thinsp;20% (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05; Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOf the 18 patients who underwent bone puncture, 15 had elevated eosinophils in bone marrow. Elevated serum IgE levels were observed in 24/25 cases (96.0%). All 21 patients who were tested for C-reactive protein had normal levels.\u003c/p\u003e \u003cp\u003eLymphatic tissue hyperplasia was observed in all surgical specimens, accompanied by reactive germinal centers, eosinophil infiltration, and occasional eosinophilic microabscess. Immunohistochemistry was performed in 36 patients; 35 (97.2%) were positive for cluster of differentiation (CD)20, 34 (94.4%) for CD3, 29 (80.6%) for CD21, 14 (38.9%) for CD30, and 11 (30.6%) for CD1a. Additionally, 15 patients (41.7%) were positive for B cell lymphoma (Bcl)-2, 10 (27.8%) for Bcl-6, and 1 (2.8%) for cytokeratin AE1/AE3. Ki-67 was expressed to varying degrees in all patients.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eAnalysis of disease characteristics of KD patients with renal impairment\u003c/h2\u003e \u003cp\u003eRoutine urine and renal function at diagnosis were available for 55 patients. Renal involvement was observed in 12 patients (12/55, 21.8%); 8 were treated with oral corticosteroids alone or combined with immunosuppressants and achieved complete remission. One patient had a 6-month history of renal impairment and was treated with rituximab without achieving remission. One patient had reduced renal function and underwent renal transplantation for a subcutaneous mass; 2 patients underwent only surgical resection of the subcutaneous tumor, and gradually became negative for urine proteins. Three patients underwent renal biopsy, and the pathologic finding was minimal change glomerulopathy without (2 patients) or with (1 patient) mild mesangial proliferative IgA nephropathy. The latter patient had renal interstitium with small focal scattered eosinophil infiltrates (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSerum albumin and total protein levels were significantly lower in patients with vs. those without renal impairment (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05); there were no significant differences in age; sex ratio; pruritus; disease location; hemoglobin; neutrophil, lymphocyte, eosinophil, and basophil counts; blood lipids; serum creatinine; and uric acid between groups (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eTreatment methods and recurrence\u003c/h2\u003e \u003cp\u003eAccording to previous studies, an increase in tumor diameter or the presence of a new mass was considered as recurrence\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e in this study. The recurrence rate was 68.4% with surgical resection, 83.3% with oral corticosteroids, 33.3% with surgical resection\u0026thinsp;+\u0026thinsp;oral corticosteroids or oral corticosteroids\u0026thinsp;+\u0026thinsp;immunosuppressants, 25.0% with surgical resection\u0026thinsp;+\u0026thinsp;oral corticosteroids\u0026thinsp;+\u0026thinsp;immunosuppressant, and 0% with surgical resection\u0026thinsp;+\u0026thinsp;radiotherapy (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). A total of 37/70 patients (52.9%) relapsed after treatment; of these, 10 received no further treatment, 11 underwent surgical resection, 6 were treated with oral corticosteroids and/or immunosuppressants, 3 underwent surgical resection and received oral corticosteroids and/or immunosuppressants, 3 received radiotherapy, 2 patients were treated with etanercept, 1 underwent surgical resection and received radiotherapy combined with tegafur, and 1 was treated with omalizumab.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eRisk factors for KD recurrence\u003c/h2\u003e \u003cp\u003eAccording to the results of a univariate analysis, peripheral blood eosinophil percentage\u0026thinsp;\u0026ge;\u0026thinsp;20%, maximum diameter of mass\u0026thinsp;\u0026ge;\u0026thinsp;3 cm, and multisite disease were included in the multivariate logistic regression model along with age and sex to identify risk factors for KD recurrence. The results showed that peripheral blood eosinophil percentage\u0026thinsp;\u0026ge;\u0026thinsp;20%, maximum diameter of mass\u0026thinsp;\u0026ge;\u0026thinsp;3 cm, and multisite disease were significant risk factors (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05; Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGeneral and recurrent conditions of 70 patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo. of patients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo. of recurrent patients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.290\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e61 (87.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34 (55.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (12.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.063\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.969\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32 (45.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17 (53.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24 (34.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13 (64.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnatomical location\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHead and neck\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43 (61.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17 (39.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther parts of the head and neck\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (8.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHead and neck and other parts\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21 (30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17 (80.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMass size\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.523\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;3 cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30 (42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 (36.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3 cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40 (57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26 (65.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePruritus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.727\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.099\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37 (52.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23 (62.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33 (47.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14 (42.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAllergic history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.462\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (11.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e62 (88.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34 (54.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.411\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (8.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e64 (91.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35 (54.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e66 (94.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35 (53.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.986\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.321\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21 (30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13 (61.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49 (70.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24 (48.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol drinking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.850\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.091\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12 (17.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e58 (82.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28 (48.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRenal impairment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.215\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.137\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12 (17.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e58 (82.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33 (56.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePercentage of eosinophils\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.672\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;20%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e34 (48.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13 (38.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;20%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36 (51.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eData are presented as n (%).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u0026mdash;, Using Fisher\u0026rsquo;s exact probability method.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinicopathologic features of 12 cases of Kimura disease with comorbid renal impairment\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"15\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient no.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge,\u003c/p\u003e \u003cp\u003eyears\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSerum IgE,\u003c/p\u003e \u003cp\u003eIU/ml\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEo%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCreatinine,\u003c/p\u003e \u003cp\u003e\u0026micro;mol/l\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eeGFR,\u003c/p\u003e \u003cp\u003emin\u0026middot;1.73 m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAlbumin,\u003c/p\u003e \u003cp\u003eg/l\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTotal protein,\u003c/p\u003e \u003cp\u003eg/l\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eUrine protein\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eUrinary red blood cells,\u003c/p\u003e \u003cp\u003e/ml\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003e24-h Urine protein,\u003c/p\u003e \u003cp\u003eg\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003eRenal pathology type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c14\"\u003e \u003cp\u003eBone puncture\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c15\"\u003e \u003cp\u003eTreatment\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e426\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e103.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e44.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e67.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eSurgical excision\u0026thinsp;+\u0026thinsp;oral corticosteroids\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1997\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e92.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e20.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e40.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e++++\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eMCD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eSurgical excision\u0026thinsp;+\u0026thinsp;rituximab\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e18.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e124.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e43.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e64.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eSurgical excision\u0026thinsp;+\u0026thinsp;oral corticosteroids\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e22.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e109.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e67.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026plusmn;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eOral corticosteroid\u0026thinsp;+\u0026thinsp;cyclophosphamide\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e48.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e133.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e22.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e67.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eSurgical excision\u0026thinsp;+\u0026thinsp;leflunomide\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1423\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e48.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e86.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e45.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e70.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026plusmn;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eSurgical excision\u0026thinsp;+\u0026thinsp;radiotherapy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e743\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e16.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e193\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e40.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e17.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e37.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e++++\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e12.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eMCD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eSurgical excision\u0026thinsp;+\u0026thinsp;tacrolimus\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e21.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e826\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e6.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e34.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e58.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026plusmn;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eSurgical excision\u0026thinsp;+\u0026thinsp;renal transplantation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e30.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e67.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e38.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e59.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eSurgical excision\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e24.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e67.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e62.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026plusmn;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eSurgical excision\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;2500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e44.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e125.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e42.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e+++\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e11.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eMCD with IgAN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eSurgical excision\u0026thinsp;+\u0026thinsp;oral corticosteroids\u0026thinsp;+\u0026thinsp;MMF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e25.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e130.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e41.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e64.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026plusmn;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eSurgical excision\u0026thinsp;+\u0026thinsp;oral corticosteroids\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"15\"\u003eeGFR, estimated glomerular filtration rate; Eo%, proportion of peripheral blood eosinophils; F, female; IgAN, mild mesangial proliferative IgA nephropathy; IgE, immunoglobulin E; M, male; MCD, minimal change disease; MMF, mycophenolate mofetil; NA, not available.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical data of patients with or without renal impairment\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical characteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWithout renal impairment\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;43)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWith renal impairment\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;12)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e/\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e/\u003cem\u003et\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37 (86.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (83.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e34.72\u0026thinsp;\u0026plusmn;\u0026thinsp;16.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.25\u0026thinsp;\u0026plusmn;\u0026thinsp;17.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.658\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.513\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePruritus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25 (58.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (58.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.990\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultiple site\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16 (37.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.511\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEo% \u0026ge;20%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19 (44.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.897\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.168\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin, g/l\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e140.0 (132.95,150.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e145.50 (102.68,156.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.174\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.862\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeutrophils, 10\u003csup\u003e9\u003c/sup\u003e/l\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.87 (2.93,4.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.23 (2.62,4.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;1.444\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.149\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLymphocytes, 10\u003csup\u003e9\u003c/sup\u003e/l\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.38 (1.57,2.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.08 (1.57,2.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.733\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.464\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMonocytes, 10\u003csup\u003e9\u003c/sup\u003e/l\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.52 (0.40,0.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.44 (0.35,0.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;1.677\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.093\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEosinophils, 10\u003csup\u003e9\u003c/sup\u003e/l\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.06 (0.41,2.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.39 (0.91,2.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.910\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.363\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTriglycerides, mmol/l\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.19 (0.96,1.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.19 (0.80,1.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.328\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.743\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCholesterol, mmol/l\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.59 (3.42,4.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.02 (3.44,8.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.984\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.325\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCreatinine, mmol/l\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e66.00 (59.75,79.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e74.00 (54.75,126.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;1.477\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.140\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUric acid, \u0026micro;mol/l\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e290.15\u0026thinsp;\u0026plusmn;\u0026thinsp;82.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e292.83\u0026thinsp;\u0026plusmn;\u0026thinsp;70.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.919\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlbumin, g/l\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44.15 (42.20,46.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34.85 (19.43,43.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;3.109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal protein, g/l\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e69.74\u0026thinsp;\u0026plusmn;\u0026thinsp;4.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58.64\u0026thinsp;\u0026plusmn;\u0026thinsp;11.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.277\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eData are presented as n (%), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, or median (interquartile range).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u0026mdash;, Using Fisher\u0026rsquo;s exact probability method.\u003c/p\u003e \u003cp\u003eEo, proportion of peripheral blood eosinophils.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRecurrence rate in patients according to treatment\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical management\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of treatments\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber of recurrences\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRecurrence rate\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical excision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e68.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOral corticosteroids\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e83.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical excision\u0026thinsp;+\u0026thinsp;oral corticosteroids\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOral corticosteroids\u0026thinsp;+\u0026thinsp;immunosuppressants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical excision\u0026thinsp;+\u0026thinsp;oral corticosteroids\u0026thinsp;+\u0026thinsp;immunosuppressants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical excision\u0026thinsp;+\u0026thinsp;radiotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate logistic regression analysis of risk factors for recurrence of Kimura disease\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eWald χ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eOR\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e95% \u003cem\u003eCl\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;0.577\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.891\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.420\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.517\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.562\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.098\u0026ndash;3.217\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.665\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.972\u0026ndash;1.045\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaximum diameter of mass\u0026thinsp;\u0026ge;\u0026thinsp;3 cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.835\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.724\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.428\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6.267\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.517\u0026ndash;25.892\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther parts of head and neck\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.522\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.804\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.843\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e12.450\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.576\u0026ndash;60.162\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEo% \u0026ge;20%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.386\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.595\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.417\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.245\u0026ndash;12.845\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eData are presented as n (%), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, or median (interquartile range).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u0026mdash;, Using Fisher\u0026rsquo;s exact probability method.\u003c/p\u003e \u003cp\u003eCI, confidence interval; Eo, proportion of peripheral blood eosinophils; OR, odds ratio; SE, standard error.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eKD was first identified and described as eosinophilic hyperplastic lymphogranuloma in 1938 by Xianzhai Jin\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e, a Chinese medical scientist. The pathologic features were described in detail by Kimura and colleagues and the disease has since been widely known as KD\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Most cases of KD have been identified in Asia, mainly in young men with head and neck involvement\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. In the present study we present data for 70 cases of KD at our hospital in the last 9 years, making this the largest single-center study of KD to date. The male-to-female ratio was about 6.8:1, with 45.7% of patients between 20 and 40 years old and 91.4% having head and neck masses. The lesions mainly involved salivary glands, the preauricular area, and cervical lymph nodes, which is consistent with the literature\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. The etiology of the disease remains unclear and may be related to immune system dysfunction, viral or parasitic infection, or allergic reaction\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Viruses and parasites can alter T cell-mediated immune regulation or induce IgE-mediated type 1 hypersensitivity, leading to the release of eosinophil factors such as interleukin (IL)-4 and IL-5\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e; thus, most patients with KD show peripheral blood eosinophilia and elevated blood IgE levels. In our study, 80% of patients had increased eosinophil counts in peripheral blood, 96.0% of the 25 patients who were tested had elevated IgE levels, and 83.3% of the 18 patients who underwent bone marrow aspiration had elevated bone marrow eosinophils. Additionally, 52.9% of patients had itchy skin as a symptom, possibly due to nerve infiltration of lymphocytes and eosinophils\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. In terms of pathologic manifestations, cell proliferation in lymphoid tissue with reactive germinal centers and massive eosinophil infiltration were observed in the surgically resected specimens of all patients in this study; in some cases, well-formed lymphoid follicles were observed and occasionally, eosinophilic microabscesses. Immunohistochemical analysis revealed CD20, CD21, and CD3 positivity in most patients and CD30, CD1a, Bcl-2, and Bcl-6 positivity in some. AE1/AE3 expression was rare, and Ki-67 was expressed to varying degrees in all specimens.\u003c/p\u003e \u003cp\u003eKD is a systemic disease that affects internal organs along with the skin and lymph nodes, causing elevated levels of eosinophils and IgE in peripheral blood. In our study, 1 patient underwent gastrointestinal endoscopy for gastrointestinal symptoms that were suggestive of eosinophilic gastroenteritis. In 1 patient, the proportion of eosinophils was 64.2% in peripheral blood and 46.8% in bone marrow; the lesion involved the right iliac vessels and ureters, and the patient ultimately developed respiratory failure, suggesting pulmonary infiltration of eosinophils. KD has a high rate of renal involvement (nephrotic syndrome). An earlier study showed that 12\u0026ndash;16% of KD patients developed proteinuria\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e, of which 60\u0026ndash;78% presented with nephrotic syndrome. In our study, 21.8% of patients had renal impairment, which is slightly higher than previously reported and may be attributable to the growing awareness among clinicians of KD and its impact on the kidney. The pathologic manifestations of KD-related nephropathy vary; according to one report\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e, of 2 patients with KD and nephrotic syndrome, 1 presented pathologically with focal glomerulosclerosis and another with chronic tubulointerstitial nephritis with mesangial proliferative glomerulopathy and focal segmental glomerulosclerosis. Both patients received oral corticosteroids therapy, but the latter progressed to end-stage renal disease as a result of self-discontinuation. In our study, renal puncture was performed in 3 patients and the pathologic finding was minimal change disease, including 1 patient who also had IgA nephropathy and small focal scattered eosinophil infiltrates in the renal interstitium\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e, which may be a typical change resulting from eosinophil invasion. Four patients (cases 3, 5, 8, and 12) developed nephrotic syndrome before the diagnosis of KD, and case 8 underwent renal transplantation for renal failure. A total of 8 patients were treated with oral corticosteroids alone or combined with immunosuppressants such as tacrolimus, resulting in total relief of nephrotic syndrome in all cases. Two patients also gradually became negative for urine proteins after surgical resection of the lesion. Both glucocorticoids and immunosuppressive agents are effective in the treatment of KD and nephrotic syndrome, which may reflect a similarity in the immunopathogenesis of these diseases\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. Glucocorticoids are known to regulate lymphopoiesis and T cell proliferation, suggesting that defects in T cell immune regulation play a role in the their pathogenesis\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e; cytokines released by activated T cells may increase the permeability of the glomerular basement membrane, leading to proteinuria\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. We compared clinical data of patients with vs. without renal impairment, and found that the former had lower albumin and total protein levels although there were no differences in their clinical manifestations, eosinophil ratio, creatinine, etc. A recent study\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e compared the clinical data of 18 KD patients with and 31 without renal impairment but did not find significant differences in laboratory parameters, clinical manifestations, or medical history between the 2 groups. Thus, the mechanism of renal impairment in KD requires further investigation.\u003c/p\u003e \u003cp\u003eThere is still no consensus on the treatment of KD. In our cohort, 38 patients underwent surgical resection; 68.4% subsequently had tumor recurrence at the original or other sites and 8 of the patients underwent a second operation. One patient had 3 operations to remove elbow, neck, and groin masses at another hospital before visiting ours, followed by oral prednisone and leflunomide; however, when the drug treatment was tapered to discontinuation, the patient again developed neck masses. The high recurrence rate in KD may be related to the fact that lesions mostly involve nerves and poorly demarcated subcutaneous tissues, and it is difficult to obtain negative margins by surgical resection. The combination of surgery and postoperative intervention can reduce the recurrence rate of the disease. Oral corticosteroids and immunosuppressants may be effective in the treatment of KD, and long-term maintenance therapy could prevent recurrence, although patients are prone to recurrence after drug withdrawal\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. In the present study, 6 patients were treated with a single cycle of corticosteroid therapy and 5 experienced recurrence, which presented as a new mass or increased diameter of the original tumor. Of the 6 patients treated with corticosteroids combined with cyclophosphamide, cyclosporine, and other immunosuppressive agents, 2 showed recurrence; the recurrence rate was the same as for surgery combined with corticosteroids, but was reduced to 25% when surgery was combined with both corticosteroids and immunosuppressive agents. Therefore, immunotherapy can be considered for patients with KD involving internal organs such as kidney or those with multiple lesions\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. Six of our patients were initially treated with surgery combined with radiotherapy to control the disease, and none have experienced recurrence, so low-dose radiotherapy is an option for patients with a wide range of lesions, difficulty in complete resection, or a high risk of recurrence\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. However, radiotherapy can cause serious side effects, which can increase patients\u0026rsquo; concerns regarding long-term treatment. Given that KD is an essentially benign disease, it is important to carefully weigh the advantages and disadvantages of this treatment modality before it is administered to patients.\u003c/p\u003e \u003cp\u003ePossible risk factors for KD recurrence include peripheral blood eosinophil counts and IgE levels, lesion size and duration, and whether the lesion boundary is clear\u003csup\u003e[\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e. Our study of 70 patients showed that lesion diameter\u0026thinsp;\u0026gt;\u0026thinsp;3 cm, proportion of eosinophils in peripheral blood\u0026thinsp;\u0026gt;\u0026thinsp;20%, and multisite disease significantly increased the risk of recurrence. Whether it is possible to predict KD recurrence based on peripheral blood eosinophil and IgE levels, which could guide treatment, will be the focus of future research.\u003c/p\u003e \u003cp\u003eIn conclusion, this study summarized and analyzed the clinical manifestations, pathologic features, renal damage, treatment methods, and recurrence rate of KD\u0026mdash;a very rare inflammatory disease\u0026mdash;in 70 patients at our hospital over the last 9 years in order to provide a reference for clinicians to recognize and treat this disease. Although KD is benign, it can affect multiple organ systems and recurrence is common. Combination therapy was superior to surgery alone in relieving symptoms. In patients with painless tumors in the head and neck, if peripheral blood eosinophils and IgE are significantly increased, a diagnosis of KD should be considered. Timely examination to identify the organs involved and implementation of active treatment are critical for reducing the risk of recurrence and improve prognosis.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWHZ was responsible for manuscript writing and statistical analysis; HJT was responsible for collection of clinical data; SGS was responsible for patients\u0026rsquo; clinical follow-up; YLZ was responsible for the research design. The author(s) read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFUNDING\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the National Natural Science Foundation of China (grant numbers 81600555), the China Postdoctoral Science Foundation (grant number 2018M640684).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Institutional Ethics Committee of The First Affiliated Hospital of Zhengzhou University, and conforms to the ethical guidelines of the Declaration of Helsinki. Requirement for individual patient consent forms was waived due to the retrospective, observational nature of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors report no competing of interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1The First Affiliated Hospital of Zhengzhou University, Department of Nephrology,Zhengzhou 450052\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKottler D, Barete S, Quereux G, et al. Retrospective Multicentric Study of 25 Kimura Disease Patients: Emphasis on Therapeutics and Shared Features with Cutaneous IgG4-Related Disease[J]. Dermatology. 2015;231(4):367\u0026ndash;77. 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Clin Imaging. 2012;36(4):272\u0026ndash;8.DOI:10.1016/j.clinimag.2011.11.002.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang Y, Bao H, Zhang X, et al. Kimura's disease: clinical characteristics, management and outcome of 20 cases from China[J]. Clin Exp Rheumatol. 2022;40(3):532\u0026ndash;8. DOI:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.55563/clinexprheumatol/lahgfo\u003c/span\u003e\u003cspan address=\"10.55563/clinexprheumatol/lahgfo\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIwai H, Nakae K, Ikeda K, et al. Kimura disease: diagnosis and prognostic factors[J]. Otolaryngol Head Neck Surg. 2007;137(2):306\u0026ndash;11. DOI:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.otohns.2007.03.027\u003c/span\u003e\u003cspan address=\"10.1016/j.otohns.2007.03.027\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Kimura disease, Eosinophilic hyperplastic lymphogranuloma, Nephrotic syndrome","lastPublishedDoi":"10.21203/rs.3.rs-2166793/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2166793/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo analyze the disease characteristics of patients with Kimura disease (KD) and provide reference for clinical practice.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eLaboratory data of 70 patients with KD diagnosed based on pathology at the First Affiliated Hospital of Zhengzhou University from August 2012 to December 2021 were collected. Clinical manifestations, renal involvement, treatments, and risk factors for recurrence were analyzed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong the 70 patients, 61 were male and 9 were female; 61.4% of patients (43/70) had focal masses only in the head and neck region and 30.0% (21/70) had masses not restricted to the head and neck; 52.9% (37/70) had pruritus. The proportion of eosinophils in peripheral blood was elevated in 80.0% of patients (56/70), and the level of serum immunoglobulin (Ig)E was increased in 96% (24/25). Renal damage was a complication in 21.8% of patients (12/55). Serum albumin and total protein levels were significantly lower in patients with as compared to those without renal impairment. Of the 70 patients, 37 had disease recurrence following treatment (surgical resection, oral corticosteroids, immunosuppressants, radiotherapy, or combinations thereof). Risk factors for KD recurrence were percentage of eosinophils in peripheral blood\u0026thinsp;\u0026ge;\u0026thinsp;20%, maximum diameter of masses\u0026thinsp;\u0026ge;\u0026thinsp;3 cm, and masses at multiple sites (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eKD is a systemic disease involving multiple organs, especially the kidney. A better understanding of disease pathogenesis can lead to the development of effective treatments that improve the prognosis of patients.\u003c/p\u003e","manuscriptTitle":"Disease characteristics of 70 patients with Kimura disease","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-10-20 17:22:54","doi":"10.21203/rs.3.rs-2166793/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7b8ad479-57bb-4a69-9079-32c4d6f2f5c0","owner":[],"postedDate":"October 20th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2022-12-05T12:14:53+00:00","versionOfRecord":[],"versionCreatedAt":"2022-10-20 17:22:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2166793","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2166793","identity":"rs-2166793","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}