Identification of viruses in the urine of renal transplant recipients by cytomorphology.

This study was designed to reassess the cytomorphology of viral infections in urinary cells obtained from renal transplant patients and to examine the association, if any, between these cytologic changes and the transplant rejection. A total of 2,354 cytologic specimens obtained from 91 renal transplant recipients was evaluated. A combination of techniques, including cellulosic filters, immunofluorescence, hemagglutination inhibition and electron microscopy, was utilized. Cytologic observations were correlated with the patient's clinical history. Thirty-eight patients revealed cytologic evidence of viral infections (herpes simplex, cytomegalovirus and papovavirus). These viral infections had distinct cytomorphology. Cytomegalovirus infection may manifest as intracytoplasmic, orangeophilic inclusions, in addition to the classical intranuclear inclusion. In the majority of renal transplant patients there appeared to be no relationship between the viral infection and the renal transplant rejection episodes.

Exfoliative cytology in the diagnosis of immunologic rejection in the transplanted kidney.

Urinary cytology was used in the study of 57 patients who received renal allografts. In general, there was close correlation between the cytologic and clinical evidence of rejection and, at least in some instances, rejection was detected cytologically prior to the onset of clinical signs and symptoms. A cytologic profile associated with rejection was established. This had as its main feature an increased number of tubular cells, particularly those that were small and degenerating. An associated background of cellular debris and casts was found to be of major significance. Intranuclear inclusions suggestive of viral infections were present in 15 patients. Cellular atypias caused by factors other than immunologic rejection were seen but none were of a malignant nature. It was considered of importance that the method described in this study could be carried out in a routine diagnostic cytopathology laboratory by cytotechnologists and cytopathologists who had received only a brief period of special training in the field of transplant cytology.

Urinary cytologic changes after radiotherapy of renal transplants.

Significant changes in the urinary cellular pattern can be attributed to renal allograft radiation, as distinct from those associated with immunologic rejection of the transplated kidney. These changes consist of nuclear multiplicity, wrinkling of the nuclear membrane, a "coffee bean" appearance of the nucleus, and increase in nuclear size, areas of decreased density and vacuolation of the cytoplasm, and perinuclear halos. The severity of the changes was categorized as "mild", "moderate", or "marked", according to the number of the above changes which were present, and was more evident in cells of transitional epithelial origin than of tubular origin. Some correlation was found between the severity of the cellular radiation changes and the survival time of the kidney.