The Role of Urine Cytology for ‘Decoy Cells’ as a Screening Tool in Renal Transplant Recipients

Abstract

Objective: To determine the role of urine cytology for ‘decoy cells’ as a screening tool for polyomavirus type BK (BKV) infection in renal transplant recipients. Study Design: This was a prospective cohort study of patients undergoing renal transplantation between 2006 and 2010. Results: A total of 442 patients underwent urine cytology for decoy cells, 27.8% underwent 1 examination only and 72.2% more than one. Of the 1,713 examinations reviewed, 426 (24.9%) were positive and 785 (45.8%) were negative for ‘decoy’ cells, 380 (22.2%) showed degenerated tubular cells and 122 (7.1%) were unsatisfactory for analysis. Urine cytology was found to have a specificity of 68.5%, a sensitivity of 84.6%, a positive predictive value of 21.2%, a negative predictive value of 97.8% and an overall accuracy of 69.9%. The incidence of polyomavirus nephropathy among the patients investigated was 11.8%. Of the 442 patients, 32 (7.2%) had graft loss, which was attributed to BKV nephropathy in 2 (6.2% of the 32). Conclusions: Urine cytology is an effective screening method for monitoring renal transplant patients, with high sensitivity and a high negative predictive value, and can therefore be used routinely in the follow-up of renal transplant patients.

JC and BK virus DNA detection in archival slides of urine cytospin from renal transplant patients

“…In our study, 9/44 (20.4%) patients had cytology positive for decoy cells. Our results are consistent with data from the literature . The presence of decoy cells is a sensitive (100%) measure but has a low positive predictive value of 29% for diagnosing NBKV .…”

Significance, cytomorphology of decoy cells in polyomavirus-associated nephropathy: Review of clinical, histopathological, and virological correlates with commentary

“…[45][46][47][48][49][50][51][52][53][54][55][56] Therefore, the decoy cell cytomorphologic template may be relevant for both BK and JC polyomavirocytes arising from any locus throughout the urinary tract. Unlike surgical biopsy, voided urine cytopathology may sample the entire urinary tract and because of this expanded degree of representation may prove sensitive in revealing PyV involvement through the detection of urinary decoy cells.…”

Correlation between the presence of degenerated inclusion‐bearing cells in voided urine samples and the occurrence of polyomavirus infection

“…Urine cytology allows the early identification of BKV infection, providing the opportunity for an intervention involving the reduction of immunosuppression in order to control and prevent the replication of BKV and thus reduce the risk of organ rejection . Microscopic examination of the urine, using Papanicolaou staining to identify the decoy cells, could also find degenerated inclusion‐bearing cells (degenerated cells) in renal transplant patients.…”