Kidney autopsy

Author: Mikael Häggström

Basic autopsy cutting

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

Comprehensiveness

On this resource, the following formatting is used for comprehensiveness:

• Minimal depth
• (Moderate depth)
• ((Comprehensive))

The kidneys are equally sized / (of normal size, with a total weight of ___ g)((a weight of ___ g on the right side and ___ g on the right)).

Sex	Weight, reference range
	Right kidney	Left kidney	Total
Men	80–160 g (2.8–5.6 oz)	80–175 g (2.8–6.2 oz)	160-335g (5.6-12.8 oz)
Women	40–175 g (1.4–6.2 oz)	35–190 g (1.2–6.7 oz)	75-365g (2.6-12.9 oz)

(No abnormal adhesions between the kidneys and surrounding fibrous capsules.)
The kidneys have smooth surfaces/ {{<<Finely / Coarsely>> granular brown surface, possibly indicating benign nephrosclerosis. There are a few cysts on the surface containing clear fluid}}. Cut surfaces have well-defined medulla, cortex, and papillae. {{The cortices and/or medullas are narrowed and congested. The papillary portions are intact.}}
The renal pelvis and ureters are unremarkable /( Renal pelvis and ureters have normal calibers, with non-irritated mucosal surfaces and open lumens).

Fixation

Generally 10% neutral buffered formalin.

  See also: General notes on fixation

Microscopic evaluation

The main findings to look for:

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.

• Two glomeruli in diabetic nephropathy: the acellular light purple areas within the capillary tufts are the destructive glomerular matrix deposits.
  Two glomeruli in diabetic nephropathy: the acellular light purple areas within the capillary tufts are the destructive glomerular matrix deposits.
• Proteinaceous material in Bowman's space, which is unspecific. It is present in about 5% of people aged over 60 years,[4] but also in for example hypertensive kidney disease.
  Proteinaceous material in Bowman's space, which is unspecific. It is present in about 5% of people aged over 60 years, but also in for example hypertensive kidney disease.

• Thrombi

• Thrombi (arrows) and glomerular crescent formation (dotted enclosure, in rapidly progressive glomerulonephritis, in this case due to SLE).
  Thrombi (arrows) and glomerular crescent formation (dotted enclosure, in rapidly progressive glomerulonephritis, in this case due to SLE).

Tubulointerstitial findings

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

• Distal tubular casts (in addition to interstitial inflammation and fibrosis in myeloma cast nephropathy).
  Distal tubular casts (in addition to interstitial inflammation and fibrosis in myeloma cast nephropathy).

Vascular findings

• Thrombi
• Mural deposition of amorphous material
• Vasculitis

• Fibrous intimal thickening of a small artery in hypertensive nehrosclerosis. There is also interstitial fibrosis, tubular atrophy with thickened tubular basement membranes.
  Fibrous intimal thickening of a small artery in hypertensive nehrosclerosis. There is also interstitial fibrosis, tubular atrophy with thickened tubular basement membranes.
• Histopathology of vasculitis (in systemic sclerosis): fibromuscular intimal proliferation and adventitial fibrosis
  Histopathology of vasculitis (in systemic sclerosis): fibromuscular intimal proliferation and adventitial fibrosis

Report

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

Further information: Autopsy

Main page

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