Kidney autopsy: Difference between revisions
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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''': | ||
<gallery> | |||
File:Nodular_glomerulosclerosis.jpeg|Nodular glomerulosclerosis, prompting a consideration of [[#Diabetic nephropathy|diabetic nephropathy, see section below.]] | |||
</gallery> | |||
*'''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''' | ||
<gallery mode=packed heights=200> | <gallery mode=packed heights=200> | ||
File:Micrograph of proteinaceous material in Bowman's space.jpg|Proteinaceous material in Bowman's space, see '''[[Proteinaceous material in Bowman's space]]''' | File:Micrograph of proteinaceous material in Bowman's space.jpg|Proteinaceous material in Bowman's space, see '''[[Proteinaceous material in Bowman's space]]''' | ||
</gallery> | </gallery> | ||
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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> | ||
===Diabetic nephropathy=== | |||
[[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.]] | |||
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"/> | |||
==Report== | ==Report== | ||
Revision as of 10:46, 21 February 2020
Author:
Mikael Häggström [note 1]
Basic autopsy cutting
In non-forensic autopsy, on each side:
- After evaluating the adrenal gland, dissect the renal fascia and perirenal fat laterally, and make an incision in the renal capsule. The renal capsule can then generally be loosened by hand. Note the surface texture.
- Dissect the kidney in the coronal plane, towards the hilum. Inspect the cut surfaces.
Gross report
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[note 2] | ||
| Right kidney | Left kidney | Total | |
| Men[1] | 80–160 g (2.8–5.6 oz) | 80–175 g (2.8–6.2 oz) | 160-335g (5.6-12.8 oz) |
| Women[2] | 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:[3]
Glomerular findings
- Diffuse and/or nodular mesangial sclerosis:
-
Nodular glomerulosclerosis, prompting a consideration of diabetic nephropathy, see section below.
- 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
-
Proteinaceous material in Bowman's space, see Proteinaceous material in Bowman's space
- Thrombi
-
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).
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.
-
Histopathology of vasculitis (in systemic sclerosis): fibromuscular intimal proliferation and adventitial fibrosis
Diabetic nephropathy
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.[3]
Report
- Findings and if they are consistent with already known diagnoses.
Further information: Autopsy
Notes
- ↑ 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.
- ↑ Renal weight range is the standard reference range, that is, defined as the interval between which 95% of values of a reference population fall into.
Main page
References
- ↑ Standard reference range: Molina, D. Kimberley; DiMaio, Vincent J.M. (2012). "Normal Organ Weights in Men ". The American Journal of Forensic Medicine and Pathology 33 (4): 368–372. doi:. ISSN 0195-7910.
- ↑ Standard reference range: Molina, D. Kimberley; DiMaio, Vincent J. M. (2015). "Normal Organ Weights in Women ". The American Journal of Forensic Medicine and Pathology 36 (3): 182–187. doi:. ISSN 0195-7910.
- ↑ 3.0 3.1 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:. ISSN 0893-3952.
Image sources