Diagnostic utility of urine cytology in detection of decoy cells in renal transplant patients: Report of five cases and review of literature

Santosh, Tummidi; Kothari, Kanchan; Agnihotri, Mona; Naik, Leena; Rojekar, Amey

doi:10.1002/dc.24337

Cited by 7 publications

(5 citation statements)

References 18 publications

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“…Figure 2C (g-i) show the underlying urothelium, and the appearance of different parts of the epithelium indicates lesions in the corresponding parts. Figure 2C (j-l) show a decoy cell, which is a shed renal tubular epithelial cell containing polyoma viral inclusion bodies, which are related to BKV (BK virus) infection and renal insufficiency after renal transplantation ( 24 - 26 ).…”

Section: Discussionmentioning

confidence: 99%

Performance analysis of urine formed element analyzer EH-2090 was found to have good accuracy in detecting RBCs and WBCs when compared to manual microscopic

Bai,

Xu,

2024

Transl Androl Urol

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Background EH-2090 is Mindray’s new-generation fully automatic urine formed element analyzer (hereinafter referred to as EH-2090). Currently, there are no studies on EH-2090, so we evaluated the analytical and clinical performance of this instrument to verify that it can meet daily clinical needs, and used manual microscopy as a reference method. Methods The analytical performance of the EH-2090 was first evaluated for repeatability, linearity, reproducibility, and carryover. We collected urine samples from outpatient and inpatient departments of Peking University Shenzhen Hospital. Uncentrifuged urine was compared with the EH-2090 using the Fuchs–Rosenthal counting method—a quantitative reference method for microscopy—for comparative studies in terms of red blood cell (RBC) and white blood cell (WBC) counting accuracy. Passing-Bablok regression analysis was performed for RBC and WBC counts. Two laboratory technicians performed centrifugation and manual analysis (microscopy) to evaluate its performance at detecting RBCs, WBCs, and casts, sensitivities and specificities were calculated. Results The EH-2090’s between-run reproducibility, within-day reproducibility, between-day reproducibility, and within-laboratory reproducibility for formed components of urine all met the laboratory requirements. There was a good correlation between the counting accuracy of RBCs (r=0.965, P<0.0001) and WBCs (r=0.894, P<0.0001) by the EH-2090 and the Fuchs-Rosenthal method. The positive coincidence rates of RBC and manual microscopy were 86.08% and 92.41%, respectively, and the negative coincidence rates were 88.39% and 85.81%, respectively. The positive coincidence rates before and after the WBC review were 89.33% and 92.00%, respectively, whereas the negative ones were 77.64% and 83.23%, respectively. The positive coincidence rates before and after cast review were 77.78% and 82.05%, respectively, and the negative ones were 97.09% and 93.60%, respectively. Conclusions The EH-2090 has good analytical and clinical performance. Its RBC and WBC counting accuracy correlates well with the quantitative reference method of microscopy.

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Section: Discussionmentioning

confidence: 99%

Performance analysis of urine formed element analyzer EH-2090 was found to have good accuracy in detecting RBCs and WBCs when compared to manual microscopic

Bai,

Xu,

2024

Transl Androl Urol

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“…3,4 Urine cytology is a noninvasive and low-cost technique that favors serial examinations. [5][6][7] It can offer important information about the health of the renal graft; so it can be an efficient way of monitoring these patients, providing the detection of different infectious agents. 8 Polyomavirus BK (BKV) reactivation can be diagnosed by the detection of decoy cells (DCs) in urine tests.…”

Section: Introductionmentioning

confidence: 99%

“…8 Polyomavirus BK (BKV) reactivation can be diagnosed by the detection of decoy cells (DCs) in urine tests. [7][8][9][10] Identification of DCs allows the selection of patients who are more prone to develop BKV-associated nephropathy (BKVAN), a condition that can lead to loss of graft function in up to 5% of renal transplant patients. 11 Cytomegalovirus (CMV), Herpesvirus, Human papillomavirus, and Candida sp.…”

Section: Introductionmentioning

confidence: 99%

Is There Still a Role for Urine Cytology in Kidney Transplantation? Experience Report in a Teaching Hospital

Gouvêa,

Carvalho,

Nascimento

et al. 2023

BJT

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Introduction: Urinary cytology has been used as a monitoring strategy for kidney transplant patients, live under chronic immunosuppression, as it is a non-invasive and low-cost method. The early detection of infections can prevent possible dysfunction and graft loss. However, its use has been decreased. Methods: We conducted a prospective study on voided urine samples from 29 consecutive patients undergoing kidney transplantation over a continuous period of 17 months, collected during their first-year post-transplantation. One technician prepared the samples by cytocentrifugation, Papanicolaou staining, and one pathologist analyzed them. Decoy cells (DCs) positive samples were prepared, by other two technicians, for contrast phase analysis, ultrastructural study, and immunofluorescence for SV40 T antigen. Results: We evaluated 252 urine samples from 26 patients. Two consecutive samples (0.8%) out of five, from the same patient (3.8%), referring to the fourth- and fifth-week post-transplant, showed low-grade squamous intraepithelial lesions; only rare epithelial cells with atypia of undetermined significance were detected (0.4%) in the sample corresponding to the sixth month post-transplant. The patient’s subsequent gynecological examination and Pap smear revealed no changes. Pseudohyphae and fungus yeasts were found in five samples (2.0%) from four patients (15.4%). Trichosporon sp. was identified in the urine of one of these patients. Decoy cells were detected in 25 samples (9.9 %) from six patients (23.1%). Two patients had sustained DCs shedding; one of them, presenting dirty background smears, developed Polyomavirus-associated nephropathy. Ultrastructural study of DCs showed icosahedral viral particles. Immunofluorescence (SV40 T antigen) was positive in DCs nuclei. Analysis by contrast phase was successful in samples with numerous DCs. Conclusion: Systematic urinary cytology after transplantation helps detect some infection signs. Patients with sustained DCs shedding and dirty background smears deserve special clinical attention. Electron microscopy and immunofluorescence (SV40 T antigen) are alternative techniques to detect polyomavirus reactivation. The findings suggest that urinary cytology still plays a role in kidney transplantation.

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“…3,4 A citologia de urina é uma técnica não invasiva e de baixo custo que favorece a realização de exames seriados. [5][6][7] Ela pode oferecer informações importantes sobre a saúde do enxerto renal e, por isso, pode ser uma forma eficiente de monitorar esses pacientes, proporcionando a detecção de diferentes agentes infecciosos. 8 A reativação do poliomavírus BK (BKV) pode ser diagnosticada pela detecção de "decoy cells" (DCs) em exames de urina.…”

Section: Introductionunclassified

“…8 A reativação do poliomavírus BK (BKV) pode ser diagnosticada pela detecção de "decoy cells" (DCs) em exames de urina. 7-10 A identificação de DCs permite a seleção de pacientes mais propensos a desenvolver nefropatia associada ao BKV (BKVAN), uma condição que pode levar à perda da função do enxerto em até 5% dos pacientes de transplante renal. 11 Citomegalovírus (CMV), herpesvírus, papilomavírus humano e Candida sp.…”

Section: Introductionunclassified

Existe Ainda um Papel para a Citologia Urinária no Transplante Renal? Relato de Experiência em um Hospital Universitário

Gouvêa,

Carvalho,

Nascimento

et al. 2023

BJT

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Introdução: A citologia urinária tem sido utilizada como estratégia de monitoramento dos pacientes transplantados renais, que vivem sob crônica imunossupressão, por ser um método não invasivo e de baixo custo. A detecção precoce de infecções pode prevenir possíveis disfunções e perda do enxerto. No entanto, a sua utilização tem decrescido. Métodos: Realizamos um estudo prospectivo em amostras de urina provenientes de 29 pacientes consecutivos, submetidos ao transplante renal ao longo de um período contínuo de 17 meses, coletadas durante seu primeiro ano pós-transplante. Um mesmo técnico preparou as amostras por citocentrifugação, coloração de Papanicolaou e um único patologista as analisou. Amostras positivas para “decoy cells” (DCs) foram preparadas por dois outros técnicos, para análise por microscopia de contraste de fase, estudo ultraestrutural e imunofluorescência (antígeno T SV40). Resultados: Foram avaliadas 252 amostras de urina de 26 pacientes. Duas amostras consecutivas (0,8%) dentre cinco, de uma mesma paciente (3,8%), referentes à quarta e quinta semana pós-transplante, apresentaram lesão intraepitelial escamosa de baixo grau; na amostra referente ao sexto mês pós-transplante foram detectadas apenas raras células epiteliais com atipias de significado indeterminado (0,4%); o posterior exame ginecológico da paciente e teste de Papanicolaou não revelaram alterações. Pseudohifas e esporos fúngicos foram encontrados em cinco amostras (2,0%) de quatro pacientes (15,4%). Trichosporon sp. foi identificado na urina de um desses pacientes. Decoy cells foram detectadas em 25 amostras (9,9%) de seis pacientes (23,1%). Dois pacientes tiveram eliminação sustentada de DCs; um deles, apresentando esfregaço de fundo sujo, desenvolveu Nefropatia associada ao poliomavírus. O estudo ultraestrutural das DCs mostrou partículas virais icosaédricas. A imunofluorescência (antígeno T SV40) foi positiva nos núcleos das DCs. A análise por microscopia de contraste de fase foi bem-sucedida em amostras com numerosas DCs. Conclusão: A citologia urinária sistemática após o transplante é útil na detecção de alguns sinais de infecção. Pacientes com eliminação sustentada de DCs e esfregaços de fundo sujo merecem atenção clínica especial. A microscopia eletrônica e a imunofluorescência (antígeno T SV40) são técnicas alternativas para detectar a reativação do poliomavírus. Os resultados sugerem que a citologia urinária ainda desempenha um papel no transplante renal.

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Diagnostic utility of urine cytology in detection of decoy cells in renal transplant patients: Report of five cases and review of literature

Cited by 7 publications

References 18 publications

Performance analysis of urine formed element analyzer EH-2090 was found to have good accuracy in detecting RBCs and WBCs when compared to manual microscopic

Performance analysis of urine formed element analyzer EH-2090 was found to have good accuracy in detecting RBCs and WBCs when compared to manual microscopic

Is There Still a Role for Urine Cytology in Kidney Transplantation? Experience Report in a Teaching Hospital

Existe Ainda um Papel para a Citologia Urinária no Transplante Renal? Relato de Experiência em um Hospital Universitário

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