Macrophagelike vacuolated renal tubular cells in the urine of a male with osmotic nephrosis associated with intravenous immunoglobulin therapy - A case report

BACKGROUND: Osmotic nephrosis is a form of renal tubular injury that has be en found in patients treated with intravenous immunoglobulin (IVIG). CASE: A 46-year-old male who had two courses of chemotherapy for acute myel ogenous leukemia was myelogenous leukemia was found to have refractory thro mbocytopenia. After IVIG (Sandoglobulin 12%, Novartis) administration (1 g/ kg) for five consecutive days, the patient became oliguric and eventually a nuric on the fifth dose. Hemodialysis teas initiated, and urine production was noted on day 2 of hospitalization. Routine cytologic examination of fre sh, voided urine showed numerous macrophagelike bland epithelial cells with abundant, multivacuolated cytoplasm. Cytokeratin immunostaining revealed p ositivity, thus confirming the epithelial origin of these cells. CONCLUSION: To our knowledge, this is the first such case reported in the E nglish-language cytology literature Awareness of a patient's clinical histo ry may be helpful in avoiding an incorrect diagnosis. Urine cytology may be useful in obtaining an early diagnosis of osmotic nephrosis in patients re ceiving high-dose IVIG therapy that may eliminate the need for a renal biop sy.