Unravelling the Histomorphological Features of Kidney: An Autopsy-based Study

Abstract

Introduction: Renal failure and End-stage Renal Disease (ESRD) are one of the leading causes of mortality. The presence of co-morbidities like Diabetes Mellitus (DM), Hypertension (HT), pregnancy, liver diseases, and various infections accelerates renal failure. Understanding the pathophysiology of Acute Renal Failure (ARF) is necessary to interpret and correlate the spectrum of morphologic changes associated with it. Aim: To study the aetiopathological causes of renal failure and evaluate the histopathological features associated with them. Materials and Methods: A cross-sectional autopsy-based study was performed in the Department of Pathology, Topiwala National Medical College, Mumbai, Maharashtra, India over three consecutive years. A total of 650 adult autopsies were studied. Clinical and laboratory details were obtained from hospital records. Gross and histopathological examinations were performed with a special focus on the kidneys. Special stains were performed wherever required to highlight any characteristic features. Results: It was found that males (n=460) were more affected than females (n=190). The age range was 13-90 years. The majority of autopsies were performed within 24 hours of hospital stay. Acute febrile illness was found to be the most common cause of ARF. Maximum number of cases were from medical units (n=520, 80%), followed by surgical (n=94, 14.5%) and gynaecological units (n=36, 5.5%). Features of Acute Kidney Injury (AKI) were seen in (n=374) 57.6% of cases, while Advanced Renal Disease (ARD) was noted in 10.9% of cases. Incidental findings at autopsy included two cases of renal cortical adenoma, one case each of renal cell carcinoma and medullary fibroma. Conclusion: Acute febrile illness does not just a reflect ion of co-existent pathologies but also directly contributes to mortality, possibly due to the risk of non renal complications like bleeding and sepsis. In the present study, the majority of cases were from medical units, in a young age group with a male predominance. Maximum cases had a short hospital stay. Several characteristic histopathological features in the kidney were identified in different clinical settings, aiding in pinpointing the cause of death. Autopsy findings of the kidney are indeed a treasure untouched and needs to be explored and warrants meticulous investigation.

Keywords

• acute kidney injury
• acute renal failure
• acute tubular necrosis