Maia T M C, Silva S F R, Silva S L, Holanda M C, Nascimento J M, Ferreira M V P
Federal University of Ceará, Fortaleza, Brazil.
Acta Cytol. 2011;55(5):445-8. doi: 10.1159/000329625. Epub 2011 Oct 8.
To evaluate the prevalence of BK virus (BKV) infection in renal transplant recipients based on the detection of urinary decoy cells.
Fifty transplantation patients (56% males) aged 39.9 ± 11 years were screened for urinary decoy cells. The majority (86%) had received grafts from living donors. The inclusion criteria were graft dysfunction, hematuria, and/or leukocyturia. Creatinine and urea serum levels were monitored for 6 months.
Decoy cells were found in the urine of 12 (24%) patients 1-2 years after transplantation. The immunosuppression regimens most frequently adopted by BKV-positive patients were cyclosporine + azathiprine (50%) and FK + mycophenolate mofetyl + prednisone (25%). A renal biopsy revealed normal structures in 7 patients (58.4%), BKV nephropathy with lymphomononuclear infiltrate and fibrosis in 4 patients (33.3%), and acute cellular rejection with lymphomononuclear infiltrate without fibrosis in 1 patient (8.3%). In the latter patient, BKV-associated nephropathy was confirmed by immunohistochemistry. During the first month, creatinine and urea serum levels were higher among patients with urinary decoy cells. Creatinine levels decreased between the first and the sixth months.
The finding of BKV-associated nephropathy in 33.3% of the patients with urinary decoy cells stresses the importance of screening for BKV with urinary cytology.
基于尿中诱饵细胞的检测评估肾移植受者中BK病毒（BKV）感染的患病率。
对50例年龄为39.9±11岁的移植患者（56%为男性）进行尿诱饵细胞筛查。大多数患者（86%）接受的是活体供者的移植物。纳入标准为移植肾功能障碍、血尿和/或白细胞尿。监测血清肌酐和尿素水平6个月。
移植后1 - 2年，12例（24%）患者的尿液中发现了诱饵细胞。BKV阳性患者最常采用的免疫抑制方案是环孢素+硫唑嘌呤（50%）和他克莫司+霉酚酸酯+泼尼松（25%）。肾活检显示，7例患者（58.4%）结构正常，4例患者（33.3%）有伴有淋巴细胞单核细胞浸润和纤维化的BKV肾病，1例患者（8.3%）有伴有淋巴细胞单核细胞浸润但无纤维化的急性细胞排斥反应。在后者患者中，免疫组化证实了BKV相关性肾病。在第一个月，有尿诱饵细胞的患者血清肌酐和尿素水平较高。肌酐水平在第一个月至第六个月之间下降。
33.3%有尿诱饵细胞的患者中发现BKV相关性肾病，强调了通过尿细胞学筛查BKV的重要性。
