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Urinary decoy cell grading and its clinical implications.

Myoung Ju Koh¹, Beom Jin Lim, Songmi Noh

¹Department of Pathology, Yonsei University College of Medicine, Seoul, Korea.

Korean Journal of Pathology

|October 31, 2012

Summary

High-grade decoy cell (DC) shedding in urine indicates persistent polyomavirus (PV) shedding and PV nephropathy in kidney transplant patients, but does not predict acute rejection.

Keywords:

Decoy cell Monitoring Polyomavirus nephropathy

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Area of Science:

Nephrology
Virology
Transplantation Immunology

Background:

Decoy cells (DCs) in urine are a screening marker for polyomavirus (PV) activation.
The clinical significance of DC quantity in persistent shedding, PV nephropathy, and acute rejection requires further investigation.

Purpose of the Study:

To explore the significance of decoy cell (DC) quantity in persistent shedding, PV nephropathy, and acute rejection.
To determine if high-grade DC shedding is associated with sustained PV shedding and related complications.

Main Methods:

A case-controlled study involving 88 renal allograft recipients with detected decoy cells (DCs) in urine.
Patients were categorized into high-grade (HG) (≥10 DCs/10 HPF) and low-grade (LG) (<10 DCs/10 HPF) shedding groups.
Analysis included duration of shedding, real-time polymerase chain reaction (PCR) for PV in urine and plasma, and prevalence of PV nephropathy and acute rejection.

Main Results:

High-grade shedding (HG) was significantly associated with sustained shedding (≥3 months) and longer detection periods (>1 year).
Polyomavirus (PV) detection by PCR was significantly higher in both urine and plasma of the HG group compared to the LG group.
PV nephropathy was more prevalent in the HG group (p=0.019), while acute rejection rates did not differ significantly between groups.

Conclusions:

Shedding of ≥10 decoy cells (DCs) per 10 high power fields (HPF) is linked to sustained polyomavirus (PV) shedding and PV nephropathy.
High-grade DC shedding is not a predictor of acute rejection in renal transplant patients.
Monitoring DC shedding levels can aid in assessing PV nephropathy risk in kidney transplant recipients.