Home About us Current issue Back issues Submission Instructions Advertise Contact Login   

Search Article 
  
Advanced search 
 
Saudi Journal of Kidney Diseases and Transplantation
Users online: 2286 Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size 
 


 
Table of Contents   
LETTER TO THE EDITOR  
Year : 2014  |  Volume : 25  |  Issue : 2  |  Page : 410-411
Urinary cytopathologic findings in renal allograft recipients in Sudan: Trends, outcome and challenges


1 Department of Pathology, Faculty of Medicine, University of Medical Sciences and Technology, Khartoum, Sudan
2 Faculty of Medical Laboratory Sciences, University of Medical Sciences and Technology, Khartoum, Sudan
3 Department of Urology, Faculty of Medicine, Ribat University, Khartoum, Sudan
4 Department of Medicine, Milton Keynes Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, United Kingdom

Click here for correspondence address and email

Date of Web Publication11-Mar-2014
 

How to cite this article:
Almobarak AO, Mohammed MH, Ahmed AO, Hag Ali TH, Ahmed MH. Urinary cytopathologic findings in renal allograft recipients in Sudan: Trends, outcome and challenges. Saudi J Kidney Dis Transpl 2014;25:410-1

How to cite this URL:
Almobarak AO, Mohammed MH, Ahmed AO, Hag Ali TH, Ahmed MH. Urinary cytopathologic findings in renal allograft recipients in Sudan: Trends, outcome and challenges. Saudi J Kidney Dis Transpl [serial online] 2014 [cited 2019 Jun 27];25:410-1. Available from: http://www.sjkdt.org/text.asp?2014/25/2/410/128599
To the Editor,

Urine cytology allows frequent monitoring of the intragraft events in renal transplantation and detection of infections associated with renal transplantation as a result of immunosuppres­sion, specifically BK polyoma virus (Decoy cells). [1] We conducted a cross-sectional study aimed to demonstrate the urinary cytomorphological changes among renal allograft recipients. We studied urine samples from 182 renal adult allograft recipients. All grafts were obtained from live donors. All the study population was under immunosuppressive drugs (Cyclosporine, Tacrolimus or azathioprine). Fourteen samples (7.6%) were collected during the first three months following transplantation. The slides of the centrifuged precipitates were stained with Papanicolaou and Diff Quick stains. The slides were screened by a cyto-screener and examined by a consultant cytopathologist for the presence of infectious agents and benign and malignant cellular changes. Of the 182 cases, 120 (65.9%) were negative for cytological changes, 45 (24.7%) showed bacterial infection, eight (4.4%) had BK polyoma virus infection (Decoy cells), four (2.2%) had human papilloma virus (HPV) infection (Koilocytosis) [Figure 1], three (1.6%) showed Candida and two (1.1%) had cytomegalovirus infection.
Figure 1: Percentage of distribution of urine cytology results in the study population.

Click here to view


Renal transplant recipients are at a high risk for developing infections, including opportu­nistic infections; this is generally attributed to the immunosuppression status and epidemiologic exposure to infections. During the first post­transplantation year, 40-50% of recipients expe­rience at least one infection. [2] Smears consistent with bacterial infections were the most common finding in our study; they revealed polymorphs, macrophages, necrotic debris and background of bacteria.

In our study, eight (4.4%) cases were diag­nosed to have BK polyoma virus cytological changes (Decoy cells). Human polyoma viruses are members of the Papova virus family, which have a double strand DNA-genome. [3] Recently, BK virus has been recognized as a cause of severe renal allograft dysfunction and potential graft loss, [4] which are characterized by the pre­sence of Decoy cells [5] that were reported to pre­sent in 10-19.7% of urine samples from renal transplant (RT) patients. [6],[7]

Cytomegalovirus (CMV) was observed in two urine smears (1.1%) in our study, while a study conducted in Sudan by Khalid Enan et al de­tected CMV DNA in 32.7% of the Sudanese RT recipients by real-time polymerase chain reac­tion. [8] One of the limitations of this cross-sectional study is the difficulty in assessing the potential significance of urine cytology in acute allograft rejection. This is due to the small num­bers of urine samples collected in the first three months following transplantation.

In conclusion, urinary cytology is a simple, rapid and cost-effective method, which can be used in low-resource settings. Urinary cytology is a useful screening tool for detection of infec­tions in kidney transplant patients, specifically viral infections.

 
   References Top

1.Minassian H, Schinella R, Reilly JC. Polyomavirus in the urine: Follow-up study. Diagn Cytopathol 1994;10:209-11.  Back to cited text no. 1
    
2.Fishman JA, Rubin RH. Infection in organ transplant recipients. N Engl I Med 1998;338: 1741-51.  Back to cited text no. 2
    
3.Hirsch HH, Steiger J. Polyomavirus Bk. Lancet Infectious Dis 2003;3:611-20.  Back to cited text no. 3
    
4.Randhawa PS, Demetris AL Nephropathy due to polyoma virus BK. N Engl I Med 2000; 342:1361-3.  Back to cited text no. 4
    
5.Koss LG. The urinary tract in the absence of cancer. In: Koss LG, ed. Diagnostic Cytology and its Histopathologic Basis. 4 th ed., Vol. 2. Philadelphia: L B. Lippincott; 1992. p. 890-933.  Back to cited text no. 5
    
6.Selvaggi SM. Cytologic detection of concurrent infectious agents in urines from renal transplant patients. Diagn Cytopathol 2010;38:549-50.  Back to cited text no. 6
[PUBMED]    
7.Semple K, Lovchik J, Drachenberg C. Identifi­cation of polyoma BK virus in kidney transplant recipients by shell vial cell culture assay and urine cytology. Am J Clin Pathol 2006; 126:444-7.  Back to cited text no. 7
    
8.Enan KA, Rennert H, El-Eragi AM, El Hussein AR, Elkhidir IM. Comparison of Real-time PCR to ELISA for the detection of human cyto­megalovirus infection in renal transplant patients in the Sudan. Virol 12011,8:222.  Back to cited text no. 8
    

Top
Correspondence Address:
Ahmed O Almobarak
Department of Pathology, Faculty of Medicine, University of Medical Sciences and Technology, Khartoum
Sudan
Login to access the Email id


DOI: 10.4103/1319-2442.128599

PMID: 24626015

Rights and Permissions


    Figures

  [Figure 1]



 

Top
   
 
 
    Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  
 


 
    References
    Article Figures
 

 Article Access Statistics
    Viewed1009    
    Printed10    
    Emailed0    
    PDF Downloaded221    
    Comments [Add]    

Recommend this journal