Microscopic examination of the urine helps to confirm the recovery of acute tubular necrosis after cadaveric renal transplantation: a case report.
BACKGROUND
Delayed graft function due to acute tubular necrosis (ATN) is frequently seen in kidney transplants from non-heart-beating donors. However, only a biopsy can be used to assess the severity of ATN. Therefore, we studied the validity of microscopic findings in tubular epithelial cells (TECs) from urine as a means to monitor ATN.


METHODS
The first voided urine in the morning was examined for the appearance and nuclear cytoplasmic (N/C) ratio of the TECs, using a murine staining with URO-3 monoclonal antibody to detect proximal tubular cells (PTCs).


METHODS
A 58-year-old man underwent cadaveric kidney transplantation in January, 2003 using tacrolimus, mycophenolate mofetil, and prednisone following basiliximab induction therapy. His graft did not function immediately; needle biopsy was performed on day 17. The pathological findings showed severe ATN without evidence of acute rejection. A large quantity of TECs was seen in his urine between days 7 and 14. After day 28, TECs with a large N/C ratio and that were URO-3 antibody-positive were detected. Urine volume increased gradually and hemodialysis was not necessary after day 36.


CONCLUSIONS
The presence of URO-3-positive TECs with large N/C ratios suggests the reconstruction of PTCs. Therefore, it may be useful to monitor TEC findings to assess the severity ATN after cadaveric kidney transplantation.
Setoguchi
K
K
Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
Tanabe
K
K
Ishida
H
H
Yokoyama
T
T
Tokumoto
T
T
Ishikawa
N
N
Miyamoto
N
N
Shimmura
H
H
Hayashi
T
T
Toma
H
H
D001707:Biopsy, Needle; D002102:Cadaver; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000473:pathology*; D007683:Kidney Tubular Necrosis, Acute / Q000473:pathology* / Q000628:therapy / Q000652:urine; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D014019:Tissue Donors; D016896:Treatment Outcome; D014556:Urine
D007166:Immunosuppressive Agents