He. Corey et al., URINE CYTOLOGY AND THE DIAGNOSIS OF RENAL-ALLOGRAFT REJECTION .1. STUDIES USING CONVENTIONAL STAINING, Acta cytologica, 41(6), 1997, pp. 1732-1741
OBJECTIVE: To determine the reproducibility and validity of urine cyto
logy for the diagnosis of acute renal allograft rejection (AX). STUDY
DESIGN: We conducted a blind, prospective study of 10 renal allograft
recipients. Freshly voided aliquots of urine were obtained on each hos
pital day and at each outpatient visit for 17 mean of 52.8+/-26.2 (SD)
days following transplantation. The samples were prepared by cytocent
rifugation and then stained by a modified Papanicolaou method. To dete
rmine interobserver reproducibility, the differential cell counts of t
wo blinded cytopathologists were compared. A cytodiagnosis of AR was m
ade when the urine sample contained <55% neutrophils and >20% lymphocy
tes. To determine the validity of the cytology, the result was compare
d to the histologic and clinical diagnoses. Biopsies were obtained one
hour following vascular anastomosis and at the time of graft dysfunct
ion and were scored by two blinded pathologists according to the Banff
classification. The clinical diagnosis was determined by a retrospect
ive review conducted by four blinded clinicians. RESULTS: Tile interop
erator reading of urine cytology was more reproducible than histology,
with kappa values of 0.40+/-0.15 (SE) and 0.21+/-0.10 (SE), respectiv
ely Urine cytology aas accurate for the diagnosis of AX, with a sensit
ivity of 80% and a specificity of 96% as compared to the clinical and
histologic findings. CONCLUSION: Our observations support the claim th
at urine cytology is useful for diagnosing AR.