Neutrophilic tubulitis as a marker for urinary tract infection in renal allograft biopsies with C4d deposition

Gaurav Gupta, Ron Shapiro, Alin Girnita, Ibrahim Batal, Jerry McCauley, Amit Basu, Henkie Tan, Parmjeet Randhawa

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13 Scopus citations

Abstract

BACKGROUND.: Neutrophilic tubulitis accompanied by intratubular neutrophil clusters in the renal allograft is a surrogate marker for urinary tract infection (UTI). Overlapping histologic findings can occur in antibody-mediated rejection, which is characterized by peritubular capillary (PTC) deposition of C4d. This study evaluated the incidence of UTI in biopsies with concurrent neutrophilic tubulitis and PTC C4d staining. METHODS.: Thirty-three allograft biopsies from 27 patients selected for the presence of simultaneous C4d staining and neutrophilic tubulitis were correlated with urine culture (U/C) results. RESULTS.: U/C obtained on the same day as the biopsy confirmed UTI in 13 of 33 (39%) biopsies. Among 20 patients with negative U/C; prior culture results within 10 days of the biopsy were available for nine patients, and 5 of 9 (55%) were positive. Thus, UTI was confirmed in 18 of 33 (54%) biopsies. Biopsy interpretation and clinical management was confounded by changes of concurrent acute cellular rejection and antibody-mediated rejection confirmed by demonstration of donor-specific antibodies. Combined therapy with antibiotics and antirejection medications (ART) was administered to 12 of 18 (67%) patients. CONCLUSIONS.: Neutrophilic tubulitis accompanied by neutrophil clusters in the tubular lumen is a useful marker of UTI, even in the presence of PTC C4d deposition. Therapeutic response to antibiotics is limited by co-existent T-cell or antibody-mediated rejection and underlying chronic allograft nephropathy.

Original languageEnglish
Pages (from-to)1013-1018
Number of pages6
JournalTransplantation
Volume87
Issue number7
DOIs
StatePublished - 15 Apr 2009
Externally publishedYes

Keywords

  • C4d staining
  • Neutrophilic tubulitis
  • Renal Allograft
  • Transplantation
  • Urinary tract infection

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