To describe the clinical features of Kimura’s disease (KD) presenting with renal damage as the insidious onset and major manifestation, and to improve awareness of this rare disorder when kidney involvement precedes the typical mass lesions.

The clinical data of a 65-year-old man with KD were retrospectively reviewed, including medical history, physical examination, laboratory findings, imaging studies, and histopathology. The diagnostic process and major differential considerations were analyzed in the context of the disease characteristics described in the original manuscript.

The patient presented with recurrent subcutaneous nodules and long-standing proteinuria. He had been diagnosed with nephrotic syndrome 10 years earlier and had received glucocorticoid therapy, but the diagnosis of KD had not been established at that time. On admission, multiple subcutaneous nodules were observed on the face and bilateral upper arms. Laboratory evaluation showed marked eosinophilia and elevated serum IgE, together with persistent proteinuria. Autoimmune serology, including antinuclear antibodies and antineutrophil cytoplasmic antibodies, was negative, and major inflammatory markers were not significantly abnormal. Bone marrow examination revealed increased eosinophils. Histopathological examination of the excised lesion demonstrated lymphoid follicle formation, vascular proliferation, and dense eosinophilic infiltration, which supported the diagnosis of KD. The case suggested that renal damage may precede the typical mass lesions and may dominate the clinical course for years, thereby delaying recognition. The manuscript further emphasized that KD is uncommon, often lacks specific manifestations, and may be confused with other eosinophilic or lymphoproliferative disorders, especially when kidney involvement is prominent.

Kimura’s disease may present with renal damage as an early and major manifestation rather than with typical head and neck masses alone. In patients with unexplained nephrotic-range proteinuria or chronic renal involvement accompanied by eosinophilia, elevated IgE, and subcutaneous nodules, KD should be considered. Early tissue biopsy is essential for diagnosis and may help reduce delayed recognition and inappropriate treatment.