Tatomirović Zeljka, Bokun Radojka, Ignjatović Ljiljana, Aleksić Anastasija, Skuletić Vesna, Dimitrijević Jovan
Vojnomedicinska akademija, ZPSM-Institut za patologiju, Beograd.
Vojnosanit Pregl. 2003 May-Jun;60(3):299-304. doi: 10.2298/vsp0303299t.
This paper presents our experience with cytologic examination of urine in diagnosing renal allograft dysfunction.
The study group included 23 patients with renal allograft dysfunction, selected from 56 patients who underwent renal transplantation. Etiologic diagnosis was made according to the clinical picture, histological findings during allograft biopsy, and cytologic examination of urine. Urine sediment was obtained in cytocentrifuge and was air dried and stained with May Grunwald Giemsa.
Out of 23 patients with allograft dysfunction in 18 (78.3%) patient it was caused by acute rejection, and in 5 (8.9%) patients by allograft infarction, cyclosporine nephrotoxicity, acute tubular necrosis and chronic nephropathy. In eighteen patients (78.3%) cytologic examination of urine was pathologic, while in 16 (70%) clinical and histology findings coincided with urine cytology findings. Out of 18 patients with acute allograft rejection in 15 patients cytologic examination of urine coincided with acute rejection. Out of 7 patients with expressed cyclosporine nephrotoxicity, in 5 cytologic examination of urine confirmed the cause of allograft dysfunction, as well as in one of 2 patients with acute tubular necrosis. Cytologic examination of urine indicated parenchymal damage in 2 patients with recurrent disease (membranoproliferative and focal sclerosing glomerulonephritis). In 4 of 5 patients suffering from chronic rejection in a year's monitoring period, urine sediment periodically consisted of lymphocytes, neutrophilic leucocytes, monocyte/macrophages, tubular cells and cylindres, without the predominance of any cell type. In 3 patients allograft dysfunction was caused by infective agents (bacteria, fungus, cytomegalovirus).
Cytologic examination of urine might be an alternative to histological in diagnosing acute allograft rejection and acute tubular necrosis or nephrototoxicity. Also it might indicate parenchymal disease while the importance of urine cytology in chronic allograft nephropathy needs to be investigated further.
本文介绍了我们通过尿液细胞学检查诊断肾移植功能障碍的经验。
研究组包括23例肾移植功能障碍患者，选自56例接受肾移植的患者。根据临床表现、移植肾活检的组织学结果以及尿液细胞学检查进行病因诊断。将尿液沉淀物置于细胞离心机中，空气干燥后用美蓝-吉姆萨染色。
23例移植肾功能障碍患者中，18例（78.3%）由急性排斥反应引起，5例（8.9%）由移植肾梗死、环孢素肾毒性、急性肾小管坏死和慢性肾病引起。18例（78.3%）患者的尿液细胞学检查为病理性，16例（70%）患者的临床和组织学结果与尿液细胞学结果一致。18例急性移植肾排斥反应患者中，15例尿液细胞学检查与急性排斥反应相符。7例有明显环孢素肾毒性的患者中，5例尿液细胞学检查证实了移植肾功能障碍的原因，2例急性肾小管坏死患者中有1例也是如此。尿液细胞学检查显示2例复发疾病（膜增生性和局灶性硬化性肾小球肾炎）患者存在实质损害。在5例慢性排斥反应患者中的4例，在一年的监测期内，尿液沉淀物定期由淋巴细胞、中性粒细胞、单核细胞/巨噬细胞、肾小管细胞和管型组成，无任何一种细胞类型占优势。3例移植肾功能障碍由感染因素（细菌、真菌、巨细胞病毒）引起。
尿液细胞学检查可能是诊断急性移植肾排斥反应、急性肾小管坏死或肾毒性的组织学检查的替代方法。它也可能提示实质疾病，而尿液细胞学在慢性移植肾病中的重要性需要进一步研究。
