engleski

The role of cytology in Endemic Nephropathy.

It was known for several decades that populations of endemic areas have significantly higher risk for upper urothelial cancers (UCC) than non- endemic populations. UCC occurs more frequently in women than in men, and there is no confirm and unique conclusion about their malignancy. It was observed that urotelial cancers occurs multifocal and with frequent recidives. It is very important to make dagnosis in early phase. Urine cytology as a method for diagnosis urothelial carcinoma was introduced in 1945 by Papanicolau and Marshall. Urothelial cells are present in all urine specimens and exfoliate readily from tumors of urothelial lining. Urine cytology is therefore an important primary method of diagnosis urothelial tumors and in combination with cytoscopy and biopsy, it used as an adjunct. Cytologic examination of urine is performed in screening programs of asimptomatic patients from endemic area, in the diagnostic evaluation of simptomatic patients, in the follow-up and monitoring of patients with known and treated urothelial cancers, and follow-up and monitoring of patients with renal alograft. Based on the known high sensitivity of urine cytology for nonpapillary carcinoma in situ, which is the usual precursor of invasive bladder cancer, screening programs of carefully chosen high- risk populations should yield significant results. Existing evidence establish that treatment based on early detection of bladder cancer in screened populations increases the overal length of survival. The most common presenting symptom in patients with urothelial cancers is gross hematuria. Patients with gross or microscopic hematuria must be further evaluated until the source of the bleeding has been securely established(CT, MR), because of possibility of renal adenocarcinoma. Cytologic examination of voided urine is a simple, noninvasive procedure with high sensitivity for urothelial carcinoma and should be performed in all symptomatic patients. If combined with DNA ploidy measurements and immunocytochemical studies sensitivity exceeds 80% even low-grade papillary tumors. Urine cytology is of particular value in the follow-up of patients with known and treated urothelial tumors. Low-grade papillary tumors, whether primary or recurent, cannot be readily diagnosed cytologically but bladder tumors grade II or III and all in situ and non papillary carcinomas can be diagnosed with a high degree of accuracy. Renal transplantation is accepted therapy for end stage renal failure, and cytologic examination of urine has been performed since this procedure was developed. The most commmon complications are acute allograft rejection and CMV infection. Both can be diagnosed and monitored by citologic examination. Long-term administration imunosupressive medication may be folloved transient episodes of urothelial cell atypia. Rare cases of transitional cell carcinoma have been reported. The simplicity, convenience, and relative accuracy of cytologic study of voided urine make it first line diagnostic technique.

Endemic nephropathy ; Cytology

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