Urinary cytology: a potential tool for differential diagnosis of acute kidney injury in patients with nephrotic syndrome
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RESEARCH NOTE
Urinary cytology: a potential tool for differential diagnosis of acute kidney injury in patients with nephrotic syndrome Caroline Vilas Boas de Melo1, Maria Brandão Tavares1, Paula Neves Fernandes2, Carlos Alberto dos Santos Silva3, Ricardo David Couto4, Marília Bahiense Oliveira5 and Washington L. C. dos‑Santos1*
Abstract Objective: Acute tubular necrosis (ATN) is a frequent cause of acute kidney injury (AKI). In patients with nephrotic syndrome (NS), AKI demands the differential diagnosis between ATN and rapidly progressive glomerulonephritis. In some cases, conclusive diagnosis is possible only by kidney biopsy. We aimed to study the potential use of urine cytol‑ ogy in the differential diagnosis between ATN and proliferative glomerular lesion in patients with NS. Results: Cell size analysis showed a higher proportion of small cells and a lower proportion of large cells in the urine of patients with AKI. Cells phenotypes were easily defined using cytological preparations. Leukocytes were found to be a primary classifier of NS groups, with higher number in patients with AKI and patients with proliferative glomeru‑ lar lesions. Although renal biopsy is still required for confirmative diagnosis, our data suggests that urinary cytology can be readily performed and support the differential diagnosis between proliferative glomerular lesion and ATN in patients with NS and AKI. Keywords: Acute tubular necrosis, Glomerulonephritis, Cytodiagnosis, Acute kidney injury Introduction Acute tubular necrosis (ATN) is a leading cause of acute kidney injury (AKI) in hospitalized patients [1]. The prevalence of AKI also correlates with ATN severity in patients with nephrotic syndrome (NS) [2]. Emergence of AKI in patients with NS requires the differential diagnosis between ATN alone and glomerular proliferative lesions such as in crescentic glomerulonephritis [3], since the therapeutic approach differs between these conditions. Whereas proliferative glomerulopathies require immediate immunosuppression to avoid progression to end-stage renal disease, ATN requires support treatment without immunosuppression avoiding potential *Correspondence: [email protected] 1 Fundação Oswaldo Cruz, Instituto Gonçalo Moniz, Rua Waldemar Falcão 121, Candeal, Salvador, BA CEP 40296‑710, Brazil Full list of author information is available at the end of the article
side effects [4]. Urinary sediment analysis has been used in the diagnosis of ATN and in the differential diagnosis between isolated ATN and proliferative glomerular lesion in patients with AKI [5, 6]. The presence of renal tubular epithelial cells in the urinary sediment has been considered indicative of ATN, and high number of leukocytes has been considered indicative of glomerular lesions [5–7]. However, cell identification in unstained urine sediment can be difficult, particularly in conditions of glomerular lesions associated with nephrotic syndrome, where the urinary sediment may be complex. Furthermore, studies associating urina
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