4. Hrvatski kongres kliniËke citologije 4th Croatian Congress ... - Penta

Clinical Cytology - Posters
THE VALUE OF URINARY DECOY CELL FINDING IN PATIENTS WITH KIDNEY
TRANSPLANTATION: A SINGLE CENTER EXPERIENCE
Vidas Ž1 , Mišić M2 , Pačić A4 , Jurenec F1 , Knotek M3 , Kardum-Skelin I5 1 Division of Urology, Clinical Hospital “Merkur”, Zagreb, Croatia
2 Department of Cytology, General Hospital “Dr. J. Benčević”, Slavonski Brod, Croatia
3 Department of Medicine, Clinical Hospital “Merkur”, Zagreb, Croatia
4 Department of Pathology, Clinical Hospital “Dubrava”, Zagreb, Croatia
5 Laboratory of Cytology and Hematology, Clinical Hospital “Merkur”, Zagreb, Croatia
Childhood infection with polyomaviruses leads to a life-long latent infection of renal and
urinary tract epithelia. Replication in the reno-urinary epithelium is associated with viral
cytopathic changes such as nuclear inclusions and decoy cells (DC). Three species
cause infection in humans, i.e. BK virus (BKV), JC virus (JCV), and simian virus (SV40).
During the 2005-2009 period, cytological urine analysis was performed in 154 patients
(94 male and 60 female) with kidney transplantation (n=19), simultaneous pancreaskidney
transplantation (SPKT) (n=9) and simultaneous kidney and liver transplantation
(n=2). Urine samples were analyzed according to the protocol once monthly following
transplantation. Fresh urine samples were analyzed within 15 min of sampling (not the
first morning void). Briefly, 0.5 mL urine was centrifuged in a cytocentrifuge at 600 rpm
for 5 min and slides were stained by the methods of May-Grünwald-Giemsa (MGG) and
Papanicolaou. The period from transplantation to the first occurrence of decoy cells in
the urine and the period of decoy cell persistence in the urine were assessed. The presence
of decoy cells (10 DC) and red blood cells (100
E) per cytospin smear was semiquantitatively determined, along with analysis of inflammatory
cells (neutrophilic granulocytes) and fungi. Kidney biopsy was done according to
the protocol (75% of patients), clinical indication (18% of patients), or immediately upon
transplantation as so-called zero biopsy (7% of patients). In patients where decoy cells
were detected, their sensitivity, specificity, and negative and positive predictive value for
BK nephropathy were calculated. Correlation of the study parameters was estimated by
use of Kruskal-Wallis test (Statistica 7.1). Decoy cells were found in 30 patients (20 male
and 10 female), age median 40 (range 16-69) years, at a mean of day 115 (range day 5-747)
of transplantation, whereas their presence was recorded for a mean of 141 (range 77-
771) days. Immunohistochemical staining of kidney biopsy sample for polyomavirus (BK
type) yielded positive reaction in 2/30 (7%) patients. Erythrocyturia was present in 29/30
patients with decoy cells. Up to 20 red blood cells per cytospin smear were recorded in
14 patients, more pronounced erythrocyturia (>100 red blood cells per cytospin smear)
in eight patients, and 20-100 red blood cells per cytospin smear in seven patients. The
number of decoy cells per cytospin smear generally ranged less than 10 in 25/30 patients,
whereas more than 10 decoy cells per cytospin smear were only recorded in 5/30
patients. There was no statistically significant correlation between the finding of neutrophilic
granulocytes and fungi, and the presence of decoy cells. Immunohistochemistry
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4 th Croatian Congress of Clinical Cytology / 1 st Croatian Symposium of Analytical Cytology / 2 nd Croatian Symposium of Cytotechnology