Kidney autopsy

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Author: Mikael Häggström [notes 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

In this page, the following signs and text coloring are used for comprehensiveness:

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

edit 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[notes 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/ {{Granular surface, possibly indicating benign nephrosclerosis}}. Cut surfaces have well-defined medulla, cortex, and papillae.
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

Findings

The main findings to look for:[3]

Glomerular findings

  • Diffuse and/or nodular mesangial 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
  • Congestion

Diagnoses

If indicated by findings above:

Diabetic nephropathy

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.[3]

Hypertensive nephropathy

Hypertensive nephropathy has two types:

  • Benign hypertensive nephrosclerosis: Characterized by arterial or arteriolar hyalinosis, intimal fibrosis, or medial hypertrophy.[5]
  • Malignant hypertensive nephrosclerosis: Characterized by fibrinoid necrosis (acute stage) or myointimal cell proliferation, usually with an “onion-skinning” appearance (chronic stage).[5]
Hypertensive nephropathy, showing fibrous intimal thickening (arrow), interstitial fibrosis, tubular atrophy with thickened tubular basement membranes.

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.
  2. 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.

References

  1. 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:10.1097/PAF.0b013e31823d29ad. ISSN 0195-7910. 
  2. 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:10.1097/PAF.0000000000000175. ISSN 0195-7910. 
  3. 3.0 3.1 3.2 3.3 3.4 3.5 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. 
  4. 4.0 4.1 Jean L. Olson. Renal Disease Caused by Hypertension. Abdominal Key. Citing:
    - Kaplan C, Pasternack B, Shah H, Gallo G (1975). "Age-related incidence of sclerotic glomeruli in human kidneys. ". Am J Pathol 80 (2): 227-34. PMID 51591. PMC: 1912918. Archived from the original. . 
    - Kappel, Birgitte; Olsen, Steen (1980). "Cortical interstitial tissue and sclerosed glomeruli in the normal human kidney, related to age and sex ". Virchows Archiv A Pathological Anatomy and Histology 387 (3): 271–277. doi:10.1007/BF00454830. ISSN 0340-1227. 
  5. 5.0 5.1 Liang, Shaoshan; Le, Weibo; Liang, Dandan; Chen, Hao; Xu, Feng; Chen, Huiping; Liu, Zhihong; Zeng, Caihong (2016). "Clinico-pathological characteristics and outcomes of patients with biopsy-proven hypertensive nephrosclerosis: a retrospective cohort study ". BMC Nephrology 17 (1). doi:10.1186/s12882-016-0254-2. ISSN 1471-2369.