Abstract

P693 Introduction: Human polyoma virus can cause interstitial nephritis in kidney transplants after reactivation of latent virus in renal epithelium. Currently, there is no exact knowledge about the incidence of polyoma virus infection in transplant patients or about the effect on long term transplant outcome. Diagnosis of polyoma virus disease has been based on transplant histology with cytopathic changes in the tubules associated with focal or diffuse tubulointerstitial inflammation and atrophy, findings similar to chronic allograft nephropathy. Immunohistological staining of kidney biopsies with monoclonal SV40 T-antibody and demonstration of decoy cells in the urine have recently been found useful in the diagnosis. Aims: To develop an immunostaining method of urine cytopreparations using fresh urine samples and staining with the monoclonal SV40 antibody and to compare the findings to demonstration of decoy cells in the urine or to kidney histology. Methods: Routine urine samples from pediatric kidney transplant patients collected either early after transplantation or during later controls, were cytocentrifuged and immunostained with SV40-T-ab. The number of SV40-T-antigen positive epithelial cells was counted and compared to the findings in routine urine cytology and transplant histology. Results: Immunostaining of urine cytology with SV40-T-ab demonstrated clearly the infected epithelial cells and the rate of infection could be estimated by semiquantitative counting. There was strong correlation between the findings in the urine and in the biopsies, but in the urine preparations the number of infected cells was much higher than in the biopsies. The high number of SV40 positive cells in the urine also correlated to the severity of clinical infection and to the state of transplant. Conclusion: Immunostaining of urine cytology with SV40-T-antibody seems to be useful in the diagnosis and follow-up of polyoma virus reactivation disease in transplant patients, especially in children with renal transplants.

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