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Forum Name: Miscellaneous Nephrology Topics

Question: Kidney donor - "Atypical" cells in urine - waiting for FISH


 paultond - Mon Aug 16, 2010 6:29 am

I am in the process of being approved to donate a kidney.

Microscopic blood in the urine showed up in my urine test.

I went for an ultrasound and then a CT scan of the kidneys. No stones.

I went in for a cystoscopy, which came back with no infection.

My blood is fine. Cholesterol, blood pressure, all fine.

But the urine I gave before the cystoscopy came back with "atypical cells", and I gave more urine so they can do a FISH test. It will take another week for the results to come back.

In the meanwhile, I'm a little unnerved, as I've been looking online and have seen things ranging from nothing to cancer. Can anyone chime in and let me know what is the likely thing that's going on here? The kidney is for a family member and I'm getting concerned that there's a chance I won't be able to help.
 Dr.M.Aroon kamath - Sun Aug 22, 2010 11:37 am

User avatar Hi,
False-positive results are higher in urinary cytologic specimens than in most other cytodiagnostic specimens.Transitional cells can normally show marked variation in size and shape, can be multinucleated and polyploid, and can frequently exhibit nuclear and cytoplasmic changes that can mimic malignancy.Paradoxically, cancerous cells can be composed of nearly normal-appearing monomorphic cells with bland nuclei.

False-positive diagnoses are commonly due to reactive changes as a result of viruses, stones, radiation, chemotherapy, degenerative changes, benign prostatic hyperplasia, pseudopapillary clusters, and prostatitis. The upper urinary tract (ureters and renal pelvis) specimens are the most difficult types of urinary specimens to interpret.

Polyoma virus nephritis is increasingly being recognized as a cause of allograft dysfunction and graft loss in renal transplant patients.Tubulo-interstial nephritis sets in following renal transplant due to reactivation of latent virus in renal epithelium. The epithelial cells with polyoma viral inclusions in urine cytology specimens are termed "Decoy cells", which may lead to a false positive diagnosis of urothelial cancer.

You should wait for the fluorescence in situ hybridization (FISH) test results to come in, rather than speculate.
Best wishes!

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