Kidney autopsy: Difference between revisions

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==Microscopic evaluation==
==Microscopic evaluation==
The main findings to look for:<ref name="PerroneChang2017">{{cite journal|last1=Perrone|first1=Marie E|last2=Chang|first2=Anthony|last3=Henriksen|first3=Kammi J|title=Medical renal diseases are frequent but often unrecognized in adult autopsies|journal=Modern Pathology|volume=31|issue=2|year=2017|pages=365–373|issn=0893-3952|doi=10.1038/modpathol.2017.122}}</ref>
The main findings to look for:<ref name="PerroneChang2017">{{cite journal|last1=Perrone|first1=Marie E|last2=Chang|first2=Anthony|last3=Henriksen|first3=Kammi J|title=Medical renal diseases are frequent but often unrecognized in adult autopsies|journal=Modern Pathology|volume=31|issue=2|year=2017|pages=365–373|issn=0893-3952|doi=10.1038/modpathol.2017.122}}</ref>
*'''Glomerular''' findings
===Glomerular findings===
:*Diffuse and/or nodular '''mesangial sclerosis'''
*Diffuse and/or nodular '''mesangial sclerosis'''
:*'''Mesangial hypercellularity''' (which has been defined as more than 3 cell nuclei per peripheral mesangial area on a 4-μm thick tissue section)
*'''Mesangial hypercellularity''' (which has been defined as more than 3 cell nuclei per peripheral mesangial area on a 4-μm thick tissue section)
:*'''Endocapillary hypercellularity'''
*'''Endocapillary hypercellularity'''
:*Glomerular '''basement membrane thickening and/or duplication'''
*Glomerular '''basement membrane thickening and/or duplication'''
For alterations in glomerular matrix and/or cellularity, the most common cause is ''diabetic nephropathy'', and typically presents as glomerular enlargement, mesangial sclerosis basement membrane thickening and and arteriolar hyalinosis.<ref name="PerroneChang2017"/>
<gallery mode=packed heights=200>
<gallery mode=packed heights=200>
For alterations in glomerular matrix and/or cellularity, the most common cause is ''diabetic nephropathy'', and typically presents as glomerular enlargement, mesangial sclerosis basement membrane thickening and and arteriolar hyalinosis.<ref name="PerroneChang2017"/>
File:Nodular_glomerulosclerosis.jpeg|Two glomeruli in diabetic nephropathy: the acellular light purple areas within the capillary tufts are the destructive glomerular matrix deposits.
[[File:Nodular_glomerulosclerosis.jpeg|thumb|Two glomeruli in diabetic nephropathy: the acellular light purple areas within the capillary tufts are the destructive glomerular matrix deposits.]]
</gallery>
:*'''Thrombi'''
*'''Thrombi'''
<gallery mode=packed heights=200>
<gallery mode=packed heights=200>
File:Histopathology of glomerular crescent formation and thrombi.jpg|'''Thrombi''' (arrows) and glomerular crescent formation (dotted enclosure, in rapidly progressive glomerulonephritis, in this case due to SLE).
File:Histopathology of glomerular crescent formation and thrombi.jpg|'''Thrombi''' (arrows) and glomerular crescent formation (dotted enclosure, in rapidly progressive glomerulonephritis, in this case due to SLE).
</gallery>
</gallery>
*'''Tubulointerstitial''' findings
 
:*Interstitial '''inflammation'''
===Tubulointerstitial findings===
:*Cytologic '''atypia''' in the tubular epithelial cells
*Interstitial '''inflammation'''
:*Atypical or pigmented '''casts'''
*Cytologic '''atypia''' in the tubular epithelial cells
*'''Crystals '''
*Atypical or pigmented '''casts'''
<gallery mode=packed heights=200>
<gallery mode=packed heights=200>
File:Histopathology of myeloma cast nephropathy.jpg|Distal tubular '''casts''' (in addition to interstitial inflammation and fibrosis in myeloma cast nephropathy).
File:Histopathology of myeloma cast nephropathy.jpg|Distal tubular '''casts''' (in addition to interstitial inflammation and fibrosis in myeloma cast nephropathy).
</gallery>
</gallery>
:*'''Crystals '''
 
*'''Vascular''' findings
===Vascular findings===
:*'''Vasculitis'''
*'''Thrombi'''
*'''Mural deposition''' of amorphous material
*'''Vasculitis'''
<gallery mode=packed heights=200>
<gallery mode=packed heights=200>
File:Histopathology of vasculitis in systemic sclerosis.jpg|Histopathology of vasculitis (in systemic sclerosis): fibromuscular intimal proliferation and adventitial fibrosis
File:Histopathology of vasculitis in systemic sclerosis.jpg|Histopathology of vasculitis (in systemic sclerosis): fibromuscular intimal proliferation and adventitial fibrosis
</gallery>
</gallery>
:*'''Thrombi'''
:*'''Mural deposition''' of amorphous material


==Report==
==Report==

Revision as of 10:01, 2 January 2020

Author: Mikael Häggström [note 1]

Basic autopsy cutting

In non-forensic autopsy, cut the kidneys in the coronal planes.

Fixation

Generally 10% neutral buffered formalin.

  See also: General notes on fixation


Microscopic evaluation

The main findings to look for:[1]

Glomerular findings

  • Diffuse and/or nodular mesangial sclerosis
  • Mesangial hypercellularity (which has been defined as more than 3 cell nuclei per peripheral mesangial area on a 4-μm thick tissue section)
  • Endocapillary hypercellularity
  • Glomerular basement membrane thickening and/or duplication

For alterations in glomerular matrix and/or cellularity, the most common cause is diabetic nephropathy, and typically presents as glomerular enlargement, mesangial sclerosis basement membrane thickening and and arteriolar hyalinosis.[1]

  • Error creating thumbnail:
    Two glomeruli in diabetic nephropathy: the acellular light purple areas within the capillary tufts are the destructive glomerular matrix deposits.
  • Thrombi

Tubulointerstitial findings

  • Interstitial inflammation
  • Cytologic atypia in the tubular epithelial cells
  • Crystals
  • Atypical or pigmented casts

Vascular findings

  • Thrombi
  • Mural deposition of amorphous material
  • Vasculitis

Report

  • Findings and if they are consistent with already known diagnoses.

Further information: Autopsy

Notes

  1. ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. ↑ 1.0 1.1 Perrone, Marie E; Chang, Anthony; Henriksen, Kammi J (2017). "Medical renal diseases are frequent but often unrecognized in adult autopsies ". Modern Pathology 31 (2): 365–373. doi:10.1038/modpathol.2017.122. ISSN 0893-3952. 

Image sources


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