Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland.
Clinical Virology, University Hospital Basel, Basel, Switzerland.
Transplantation. 2023 Dec 1;107(12):2568-2574. doi: 10.1097/TP.0000000000004712. Epub 2023 Jul 6.
Urine CXCL10 is a biomarker for renal allograft inflammation induced by rejection, urinary tract infection, or BK polyomavirus (BKPyV) replication. This study aimed to compare urine CXCL10 levels in different stages of BKPyV reactivation and to investigate urine CXCL10 as a biomarker for BKPyV replication.
We included 763 urine samples (235 patients) from an interventional, randomized trial obtained in the context of regular screening for urine CXCL10 levels. All urine samples had a complete urine sediment analysis, no rejection episode noted within 30 d before urine collection, and a urine decoy cell analysis was conducted within ±3 d.
Urine CXCL10 levels were 2.31 ng/mmol in samples without BKPyV viruria, slightly rose to 4.35 ng/mmol with BKPyV viruria, and then markedly increased to 16.42 ng/mmol when decoy cells were detectable, but still in the absence of BKPyV DNAemia ( P < 0.001). The highest urine CXCL10 values were observed in samples with BKPyV DNAemia (median 42.59 ng/mmol). The area under the curve of urine CXCL10 levels to detect ≥3 decoy cells was 0.816. At a CXCL10 cutoff of 3 ng/mmol, the negative predictive value was 97%. The area under the curve of urine CXCL10 levels to detect BKPyV DNAemia was 0.882, with a negative predictive value of 99% at a CXCL10 cutoff of 3 ng/mmol.
Urine CXCL10 levels are already significantly elevated in BKPyV viruria (especially with decoy cell shedding) and further increase with BKPyV DNAemia. Low urine CXCL10 values can rule out the presence of ≥3 decoy cells and BKPyV DNAemia with high certainty.
尿液 CXCL10 是由排斥反应、尿路感染或 BK 多瘤病毒 (BKPyV) 复制引起的肾移植炎症的生物标志物。本研究旨在比较 BKPyV 再激活不同阶段的尿液 CXCL10 水平，并探讨尿液 CXCL10 作为 BKPyV 复制的生物标志物。
我们纳入了一项干预性、随机试验的 763 份尿液样本（235 例患者），这些样本是在定期筛查尿液 CXCL10 水平的背景下获得的。所有尿液样本均进行了完整的尿液沉淀物分析，在尿液采集前 30 天内没有记录排斥反应事件，并且在 ±3 天内进行了尿液诱饵细胞分析。
无 BKPyV 病毒尿的样本中尿液 CXCL10 水平为 2.31ng/mmol，略有升高至 4.35ng/mmol 时有 BKPyV 病毒尿，当可检测到诱饵细胞时则明显升高至 16.42ng/mmol，但仍无 BKPyV DNA 血症（P<0.001）。在有 BKPyV DNA 血症的样本中观察到最高的尿液 CXCL10 值（中位数为 42.59ng/mmol）。尿液 CXCL10 水平检测≥3 个诱饵细胞的曲线下面积为 0.816。在 CXCL10 截断值为 3ng/mmol 时，阴性预测值为 97%。尿液 CXCL10 水平检测 BKPyV DNA 血症的曲线下面积为 0.882，在 CXCL10 截断值为 3ng/mmol 时，阴性预测值为 99%。
尿液 CXCL10 水平在 BKPyV 病毒尿（尤其是诱饵细胞脱落）中已明显升高，并随着 BKPyV DNA 血症的出现进一步升高。低尿液 CXCL10 值可以高度确定地排除存在≥3 个诱饵细胞和 BKPyV DNA 血症。
