Fonseca Luciano Espinheira, Shapiro Ron, Randhawa Parmjeet S
Department of Anatomic Pathology & Legal Medicine, Bahia Federal Medical School, Salvador, Bahia, Brazil.
Mod Pathol. 2003 Apr;16(4):281-5. doi: 10.1097/01.MP.0000062658.47481.69.
Lymphocytic tubulitis is a well-accepted criterion for acute cellular rejection in renal allograft biopsies. Neutrophilic tubulitis has been used as a surrogate marker for urinary tract infection, but it is not clear how reliably this lesion can be used to make this diagnosis. Biopsy findings were correlated with clinical features in 26 renal allograft biopsies with interstitial polymorphonuclear infiltrates associated with neutrophilic tubulitis. The grade of neutrophilic tubulitis exceeded the grade of lymphocytic tubulitis in 7 (44%) of 16 patients with, but in only 0 patients without, a positive urine culture. Culture confirmed urinary tract infection in 16 (62%) of 26 patients. It is possible that prior antibiotic therapy led to a false-negative culture and masked the diagnosis in two additional patients. Lymphocytic tubulitis made it difficult to exclude concurrent acute cellular rejection in all biopsies studied. In 6 (23%) of 26 patients, negative cultures and response to steroid treatment confirmed that neutrophilic tubulitis can occur in biopsies without urinary tract infection. The relative contributions of infection and rejection could not be determined in patients treated with both steroids and antibiotics. Neutrophilic tubulitis in a renal allograft biopsy should alert the clinician to the possibility of urinary tract infection, even if concurrent lymphocytic tubulitis is present. Confirmation by urine culture is needed because biopsies with ischemic injury and acute cellular or antibody-mediated rejection can show overlapping histology.
淋巴细胞性肾小管炎是肾移植活检中急性细胞排斥反应被广泛认可的标准。中性粒细胞性肾小管炎已被用作尿路感染的替代标志物，但尚不清楚该病变用于做出此诊断的可靠性如何。对26例伴有与中性粒细胞性肾小管炎相关的间质多形核浸润的肾移植活检组织的活检结果与临床特征进行了相关性分析。16例尿培养阳性患者中有7例（44%）中性粒细胞性肾小管炎的分级超过淋巴细胞性肾小管炎，但16例尿培养阴性患者中无此情况。26例患者中有16例（62%）培养证实存在尿路感染。另外2例患者可能由于先前的抗生素治疗导致培养结果假阴性并掩盖了诊断。在所有研究的活检组织中，淋巴细胞性肾小管炎使得难以排除并发的急性细胞排斥反应。26例患者中有6例（23%）培养阴性且对类固醇治疗有反应，证实中性粒细胞性肾小管炎可发生在无尿路感染的活检组织中。在同时接受类固醇和抗生素治疗的患者中，无法确定感染和排斥反应的相对作用。肾移植活检中的中性粒细胞性肾小管炎应提醒临床医生注意尿路感染的可能性，即使同时存在淋巴细胞性肾小管炎。由于伴有缺血性损伤以及急性细胞或抗体介导的排斥反应的活检组织可能显示重叠的组织学表现，因此需要通过尿培养进行确诊。
