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KMID : 1101220030350020163
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2003 Volume.35 No. 2 p.163 ~ p.169
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Utility of Urinary Cytology and Immunocytochemistry for Diagnosing Human Polyoma Virus Infection in Renal Transplant Recipients
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Han Kyung-Hee
Kim Tai-Jeon
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Abstract
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Human polyoma virus(HPOV) infection is associated with hemorrhagic cystitis, tubulointerstitial nephritis, and renal transplant disfunction. HPOV interstitial nephritis occurs in immunosuppressed patients after reaction to the latent virus in renal tubular epithelium. We evaluated the utility of cytologic examination from renal transplantation patients by routine light microscopy and immunocytochemical stains with antibodies against SV40, compared to histochemistry and electron microscopic study(EMS). We examined bladder washing samples from 21 patients and we concurrently obtained 17 renal biopsy specimens. Evidence of viral infection was found in 9 of 16 patients with positive HPOV by Immunocytochemical stains. Nine of 17 renal transplant biopsy specimens showed cytopathic changes in tubular cells. Three cases were diagnosed as HPOV by renal biopsy specimens and EMS. Possible explanations for not detecting HPOV histologically are due to the severe cytolysis, or inflammation caused by rejection, the infection obscuring the cytopathic effect through biopsy sampling error. Compared to immunocytochemistry, the sensitivity and specificity of urinary cytology for detecting HPOV were 56.25% and 100%, respectively. In conclusion, urinary cytology examined simultaneously with immunochemical stains is a reliable diagnostic tool for identifying viral cytopatholgic effect in urothelial cells and deserves more widespread use in the monitoring of renal trasplant patients. Our findings also indicate that sensitivity of immunocytochemical stain is increased when combined with EMS. We suggest that part of the renal biopsy sample be used simultaneously with EMS, or at least stored in EM fixative when HPOV is clinically suspected.
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KEYWORD
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Human polyoma virus, Renal transplant, Immunocytochemistry, SV40, Sensitivity, Specificity
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