[Clinical renal transplantation: exfoliative urinary cytology in the evaluation of nephrotoxicity induced by cyclosporin therapy].

Cyclosporine significantly improved the results in organ allograft, nevertheless the drug's potential nephrotoxicity is still causative of problems in differential diagnosis between rejection and graft failure due to Cyclosporine in patients who undergo kidney transplantation. The authors evaluate the effectiveness of a simple method as Urinary Exfoliative Cytology (UEC) in a group of 38 patients who received a kidney allograft and post operative treatment with Cyclosporine. The cytological parameters studied were the following: cytology: cellularity, background, urotelial cells, tubular cells, red cells, polinuclear cells, monocytes, histyocytes, lymphocytes, plasmacells, casts (from 0 to 4+). In all the patients was associated the immunological evaluation--lymphocytes subpopulation markers and function--and Cyclosporine serum levels, together with the hematochemical parameters. In 6 patients with a rise of serum creatinine level the UEC evidentiated intracytoplasmatic eosinophile inclusions in the proximal tubular cells, picture never observed in over 5000 UEC examination of patients treated with post-transplant steroids and azathioprine immunosuppressive regimen. Moreover a complete renal function recovery followed the Cyclosporine dose reduction. The authors conclude that the UEC in kidney allograft is a safe, simple and useful method to assess the early renal damage due to Cyclosporine and to make differential diagnosis between nephrotoxicity and rejection.