Sekito Takanori, Araki Motoo, Yoshinaga Kasumi, Maruyama Yuki, Sadahira Takuya, Nishimura Shingo, Wada Koichiro, Watanabe Masami, Watanabe Toyohiko, Tanabe Katsuyuki, Takeuchi Hidemi, Morinaga Hiroshi, Kitagawa Masashi, Kitamura Shinji, Sugiyama Hitoshi, Wada Jun, Yanai Hiroyuki, Nasu Yasutomo
Departments of, Urology.
Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences.
Int J Urol. 2021 Dec;28(12):1240-1246. doi: 10.1111/iju.14679. Epub 2021 Sep 1.
To investigate the association between duration of consecutive presence of decoy cells on urine cytology and BK virus nephropathy after kidney transplantation.
In total, 121 kidney transplant recipients were retrospectively evaluated. The best duration of consecutive presence of decoy cells that could be used to predict BK virus nephropathy was analyzed using the area under the curve for each duration, and recipients were divided into two groups based on the best predictive performance. The effectiveness of SV40 immunostaining on urinary cytology was also analyzed.
In total, 2534 urine specimens as well as SV40 immunostaining in 2241 urine specimens were analyzed. Six consecutive months of decoy cell positivity had the best predictive performance for BK virus nephropathy (area under the curve = 0.832). The incidence of BK virus nephropathy in recipients with positive decoy cells for 6 months or more consecutive months (5/44) was significantly higher than in those who had positive decoy cells for less than 6 months (0/77; P = 0.005). Decoy cell positivity had a sensitivity, specificity, positive predictive value, and negative predictive value for BK virus nephropathy of 100%, 66%, 11%, and 100% respectively. SV40 immunostaining provided slightly better specificity (68%) and positive predictive value (12%).
The detection of decoy cells at 6 months or more on urine cytology had high predictive value for BK virus nephropathy in kidney transplant recipients. SV40 immunostaining on urine cytology added minimal diagnostic accuracy.
探讨肾移植术后尿细胞学检查中诱饵细胞持续存在时间与BK病毒肾病之间的关联。
对121例肾移植受者进行回顾性评估。使用每个持续时间的曲线下面积分析可用于预测BK病毒肾病的诱饵细胞连续存在的最佳持续时间，并根据最佳预测性能将受者分为两组。还分析了SV40免疫染色在尿细胞学检查中的有效性。
共分析了2534份尿液标本以及2241份尿液标本中的SV40免疫染色。诱饵细胞阳性连续6个月对BK病毒肾病具有最佳预测性能（曲线下面积=0.832）。诱饵细胞连续6个月或更长时间呈阳性的受者中BK病毒肾病的发生率（5/44）显著高于诱饵细胞阳性时间少于6个月的受者（0/77；P=0.005）。诱饵细胞阳性对BK病毒肾病的敏感性、特异性、阳性预测值和阴性预测值分别为100%、66%、11%和100%。SV40免疫染色提供了略好的特异性（68%）和阳性预测值（12%）。
尿细胞学检查中6个月或更长时间检测到诱饵细胞对肾移植受者BK病毒肾病具有较高的预测价值。尿细胞学检查中的SV40免疫染色对诊断准确性的提高作用极小。
