Clinical graft evolution of lymphocytes, polymorphonuclear cells, and antigen expression in tubular renal cells in the urine sediment of 20 renal allograft recipients.

Urinary samples from 20 kidney transplant recipients were studied to determine the cellular composition of the sediments using an immunocytological (IC) technique. The expression of HLA class I (A, B, C) and class II (DR, DQ, DP), CD2, CD3, CD4, CD8, and interleukin (IL)-2 receptor (IL-2R) on lymphocytes was assessed using a panel of monoclonal antibodies. The results were correlated with graft function and with the number of episodes of acute renal graft rejection (AR) during a period of 6 months posttransplantation. The cellular infiltration of lymphocytes (LC) and polymorphonuclear cells (PMNC) also was studied using a standard cytology (SC) technique. During this period, 17 of 30 episodes of graft dysfunction due to AR occurred in 12 patients: 8 to acute tubular necrosis (ATN) (n = 8); 4 to cyclosporine (CsA) toxicity (n = 4) and 1 to amphotericin toxicity (n = 1). The diagnosis of AR was made clinically by 3 independent observers, using biopsy in some cases. The immunocytology showed a significantly increased expression of HLA-DR, DO, and DP namely, greater than 20% positivity in 10% of samples on the tubular epithelial cells (TEC) of patients presenting with versus without AR (P < or =.001). In addition, a high correlation was observed between the expression of IL-2R and the presence of AR (p < or =.002). The standard cytology results showed a significantly increased percentage of LC and decreased percentage of PMNCs in samples obtained 2 days prior to the clinical manifestations of patients who developed AR (P =.001). A greater level of expression of antigen determinants was observed prior to AR. These results suggest that immunocytology of urinary sediments, which is a noninvasive technique, has enormous clinical potential for the differential diagnosis of AR, ATN, and CsA toxicity. In our study, the use of HLA class IL-specific monoclonal antibodies (Abs) gave a 100% specificity, 95% sensitivity, and 95% predictability. Although our results also indicate a potential value in the increased IL-2R expression, these findings must be confirmed by further studies. Furthermore, the combination of both immunologic and SC techniques in urinary sediments allows early detection of AR and is cost effective and simple features that could be used routinely for follow-up of renal transplant recipients.

A prospective one-year study evaluating the clinical outcome of recipients of living donor kidneys treated with cyclosporin and azathioprine.

Thirty recipients of living related donor kidneys treated either with cyclosporin or azathioprine were evaluated clinically and functionally in a 1-year prospective study. Only the azathioprine group showed either accelerated or chronic rejection (one patient each). The azathioprine patients had higher rate of infectious episodes (P = 0.05), leukopenia (P = 0.003) and steroidal side-effects (P less than 0.007). During the early post-transplant period the renal functional performance was the same in both groups. Afterwards, however, the plasma creatinine was higher in the cyclosporin group (P less than 0.01). Mean arterial pressure remained similar throughout the study in both groups. The anaemia correction was similar in both groups but the haematocrit was greater in the cyclosporin-treated subjects (P less than 0.005).