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Cytomegalovirus in urinary sediment in patients with acute kidney injury
Sahra Pajenda1, Sebastian Kapps2, Daniela Gerges2
1Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. sahra.pajenda@meduniwien.ac.at.
Background:
Immunosuppression in solid organ transplantation is associated with frequent infections. Renal allograft recipients are susceptible to opportunistic infections and can acquire human cytomegalovirus (HCMV) infections even within the allograft. There, HCMV can be found in both the glomerulus and tubular cells, but is mostly restricted to specific and circumscribed sites. Therefore, not all organ infections are identifiable by immunohistology for HCMV proteins in fine needle core biopsies. Thus, we performed a urinalysis study to search for HCMV-specific RNA transcripts in the urine sediment of patients with acute kidney injury.
Methods:
Urinary sediment of 90 patients with acute kidney injury (AKI), including 48 renal transplant recipients (RTX) and 42 non-transplant recipients (nRTX), was collected from morning urine for RNA extraction and reverse transcription. The copy number of HCMV transcripts was evaluated using a UL132 HCMV-specific probe set and by real-time quantitative polymerase chain reaction (RT-qPCR).
Results:
Of the 48 RTX patients, ten showed HCMV copies in their urine sediment cells. Within this group, three recipients had negative HCMV serology and received an allograft from an HCMV-seropositive donor. In addition, all three RTX patients on a belatacept-based immunosuppressive regimen had HCMV transcripts in their urine. Of the 42 nRTX patients, only two had detectable HCMV transcripts in urine sediment cells and both were under immunosuppression.
Conclusions:
Ten immunosuppressed renal allograft recipients and two immunosuppressed non-transplant patients with AKI showed HCMV copies in urine sediment. Thus, HCMV positivity in urinary sediment appears to be associated with immunosuppression. This study describes a novel noninvasive method for detection of HCMV in urinary sediment. Whether all HCMV infections can be detected or only those with viral replication warrants further investigation.
Insights
Human cytomegalovirus (HCMV) RNA transcripts were detected in the urine sediment of immunosuppressed patients with acute kidney injury. This novel urinalysis method may aid in noninvasively detecting HCMV infections in renal transplant recipients.
Area of Science:
- Nephrology
- Virology
- Transplantation Immunology
Background:
- Solid organ transplantation requires immunosuppression, increasing infection risk.
- Renal allograft recipients are prone to opportunistic infections like human cytomegalovirus (HCMV).
- Current methods like immunohistology may miss localized HCMV infections in kidney allografts.
Purpose of the Study:
- To investigate the presence of HCMV-specific RNA transcripts in urine sediment of patients with acute kidney injury (AKI).
- To evaluate urinalysis as a noninvasive method for HCMV detection in renal transplant recipients (RTX) and non-transplant recipients (nRTX).
Main Methods:
- Collected morning urine sediment from 90 patients with AKI (48 RTX, 42 nRTX).
- Performed RNA extraction and reverse transcription.
- Quantified HCMV transcripts using real-time quantitative polymerase chain reaction (RT-qPCR) with a UL132-specific probe.
Main Results:
- HCMV transcripts were found in urine sediment of 10 out of 48 RTX patients.
- Three RTX patients with detectable HCMV transcripts had negative serology but received organs from seropositive donors.
- All three RTX patients on belatacept-based immunosuppression showed HCMV transcripts; two nRTX patients also tested positive.
Conclusions:
- HCMV positivity in urine sediment is associated with immunosuppression in patients with AKI.
- Urinalysis for HCMV RNA transcripts offers a novel, noninvasive detection method.
- Further research is needed to determine if this method detects all HCMV infections or only those with active viral replication.
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