Análisis morfométrico de la citología urinaria en pacientes trasplantados renales con infección del virus BK

Abstract

IntroductionThe interstitial nephritis associated with BK virus is a complication of renal transplantation. The presence of viral inclusions called «Decoy cells» in urinary cytologies and DNA viral load in plasma, urine and kidney tissue are markers of BK virus replication. ObjectiveAnalysis of urinary cytology as screening method for the early diagnosis of polyomavirus infection in renal transplant patients. Material and methodRetrospective and prospective study of 114 urinary cytologies and viral load in urine (PCR) in 33 patients with renal transplantation infection in search of BK virus. Morphometric analysis of the 4 types of viral inclusions (Decoy cells) by BK virus infection using image software NIS-Elements Advanced Research version 3.0. ResultsThe urinary cytology is an excellent screening method for the early diagnosis of polyomavirus infection in renal transplant patients with a sensitivity of 81.4% and a specificity of only 22.6%. The 4 patterns of cytomorfologics Decoy cells show a scatter area and length of less than 50% from the average value, being lower in type iv. ConclusionsThe probability of a renal transplant patient infected by the BK virus having a cytology with nuclears inclusions compatible with with Decoy cells is high but its specificity as a sign of infection and replication by BK virus is low. The 4 cytomorphologic patterns of Decoy cells should be considered as a different cell subgroups.