[Value of urinary sediment cytology in evaluation of acute tubular necrosis after kidney transplantation].
OBJECTIVE
The aim of the study was to assess the clinical value of urinary sediment cytology (USC) by use of phase-contrast microscopy in the evaluation of acute tubular necrosis (ATN) during the early period after kidney transplantation. The study was performed at the Cytology Laboratory, Department of Nephrology and Dialysis, Clinical Hospital Center Rijeka, Croatia.


METHODS
Patients included 141 kidney recipients, 99 male and 42 female, mean age 40 +/- 13 (range 8-72) years, who had received kidney allograft during the period of ten years, and who were treated at the University Department of Internal Medicine, Rijeka Clinical Hospital Center. The majority of patients (76%) had received cadaveric kidneys. Urinary sediment was analyzed for the presence of renal tubular cells, isomorphic erythrocytes, lymphocytes, casts and debris. Renal tubular cells on USC were recognized as the most constant sign of ATN. The presence of lymphocytes should arise suspicion of rejection.


METHODS
A typical cytologic profile of acute tubular lesion consists of tubular cells, isomorphic erythrocytes, casts, cellular and/or amorphic debris.


RESULTS
USC by use of phase contrast microscopy is confirmed as a method of a very high sensitivity (82%) and specificity (93%) in the evaluation of ATN in transplanted kidney patients during early post-transplantation period. In situations of coexistence of several causes of allograft dysfunction, "mixed" cytologic pictures were frequently created, from which it is difficult or almost impossible to identify the actual cause of kidney dysfunction. In these cases, the final judgment should be made solely by histologic evaluation, which still represents the gold standard in the evaluation of kidney allograft dysfunction.


CONCLUSIONS
Serial USC, when thoroughly examined using phase-contrast microscopy, is a simple, noninvasive, fast, easily repeatable and inexpensive diagnostic method of high sensitivity and specificity in the evaluation of ATN during the early phase after kidney transplantation.
Grzetić
Mirjana
M
Odjel za nefrologiju i dijalizu Klinika za internu medicinu Klinicki bolnicki centar Rijeka T. Strizića 3 51 000 Rijeka, Hrvatska. mgrzetic@medri.hr
Racki
Sanjin
S
Prodan-Merlak
Zeljka
Z
Vuksanović-Mikulicić
Sretenka
S
Zivcić-Cosić
Stela
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003581:Cytodiagnosis; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D007683:Kidney Tubular Necrosis, Acute / Q000175:diagnosis* / Q000209:etiology / Q000652:urine; D008297:Male; D008858:Microscopy, Phase-Contrast; D008875:Middle Aged; D012680:Sensitivity and Specificity; D014556:Urine / Q000166:cytology*