Urine immunocytology as a noninvasive diagnostic tool for acute kidney rejection: a single center experience [Imunocitologija urina kao neinvazivni dijagnostički postupak za otkrivanje akutnog odbacivanja bubrega: iskustvo KB »Merkur«]

Mihovilović, Karlo and Kardum-Skelin, Ika and Ljubanović, Danica and Sabljar-Matovinović, Mirjana and Vidas, Željko and Knotek, Mladen (2010) Urine immunocytology as a noninvasive diagnostic tool for acute kidney rejection: a single center experience [Imunocitologija urina kao neinvazivni dijagnostički postupak za otkrivanje akutnog odbacivanja bubrega: iskustvo KB »Merkur«]. Collegium Antropologicum, 34 (1). pp. 63-67. ISSN 0350-6134

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Abstract

Renal biopsy is a gold standard for establishing diagnosis of acute rejection of the renal allograft. However, being invasive, renal biopsy has potential significant complications and contraindications. Therefore, possibility to noninvasively diagnose acute rejection would improve follow-up of kidney transplant patients. The purpose of this study was to evaluate urine immunocytology for T cells as a method for noninvasive identification of patients with acute renal allograft rejection in comparison to renal biopsy. In this prospective study a cohort of 56 kidney, or kidney-pancreas transplant recipients was included. Patients either received their transplant at the University Hospital »Merkur«, or have been followed at the »Merkur« Hospital. Patients were subject to either protocol or indication kidney biopsy (a total of 70 biopsies), with simultaneous urine immunocytology (determination of CD3-positive cells in the urine sediment). Acute rejection was diagnosed in 24 biopsies. 23 episodes were T-cell mediated (6 grade IA, 5 grade IB, 1 grade IIA, 1 grade III and 10 borderline), while in 1 case acute humoral rejection was diagnosed. 46 biopsies did not demonstrate acute rejection. CD3-positive cells were found in 21% of cases with acute rejection and in 13% of cases without rejection (n.s.). A finding of CD3-positive cells in urine had a sensitivity of 21% and specificity of 87% for acute rejection (including borderline), with positive predictive value of 45% and negative predictive value of 68%. Although tubulitis is a hallmark of acute T cell-mediated rejection, detection of T cells in urine sediment was insufficiently sensitive and insufficiently specific for diagnosing acute rejection in our cohort of kidney transplant recipients.

Abstract in Croatian

Biopsija bubrega je zlatni standard za postavljanje dijagnoze akutnog odbacivanja bubrega u transplantaciji bubrega. Zbog svoje invazivnosti, biopsija bubrega ima kontraindikacije i značajne nuspojave. Pronalazak neinvazivne metode za dijagnosticiranje akutnog odbacivanja unaprijedilo bi praćenje transplantiranih pacijenata. Cilj ove studije je bio procjena pouzdanosti immunocitologije urina na T-limfocite, u usporedbi s biopsijom bubrega, u postavljanju dijagnoze akutnog odbacivanja u pacijenta s transplantiranim bubregom. U ovu prospektivnu studiju uključeno je 56 pacijenata s transplantiranim bubregom ili bubregom i gušteračom. Pacijenti su ili transplantirani u Kliničkoj bolnici »Merkur«, ili su samo praćeni u Kliničkoj bolnici »Merkur« nakon transplantacije u drugoj bolnici. Pacijentima su rađene protokol ili indikacijske biopsije (ukupno 70 biopsija) uz istovremenu imunocitologiju urina (određivanje CD3-pozitivnih stanica u sedimentu urina). Akutno odbacivanje je nađeno u 24 biopsije. 23 epizode odbacivanja su bile T-stanično posredovane (6 stupanj IA, 5 stupanj IB, 1 stupanj IIA, 1 stupanj III i granično 10 epizoda), dok je u jednom slučaju dijagnosticirano akutno humoralno odbacivanje. U 46 bioptičkih uzoraka nije dijagnosticirano akutno odbacivanje. CD-3 pozitivne stanice su nađene u 21% slučajeva s prisutnim akutnim odbacivanjem u biopsiji, dok je u skupini bez akutnog odbacivanja taj pozivitet je bio 13% (n.s.). Pronalazak CD-3 pozitivnih stanica u urinu imalo je osjetljivost od 21%, specifičnost od 87%, pozitivnu prediktivnu vrijednost od 45% i negativnu prediktivnu vrijednost od 68% za dijagnozu akutnog odbacivanja. Iako je tubulitis značajka akutnog odbacivanja posredovanog T-stanicama, detekcija CD-3 pozitivih stanica u sedimentu urina pokazala je nedostatnu osjetljivost i specifičnost za dokazivanje akutnog odbacivanja u našoj kohorti pacijenata sa transplantiranim bubregom.

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