title: Renal cortical pallor--a useful macroscopic marker for metabolic derangements at autopsy.
abstract: Renal cortical pallor was studied as a potential marker at autopsy of diabetic ketoacidosis in 23 cases, hyperglycemic nonketotic coma in eight cases, and alcoholic ketoacidosis in five cases (vitreous humor glucose level≥11.1 mM; β-hydroxybutyrate level≥5 mM). Renal cortical pallor was noted on macroscopic examination in 10 of 23 cases of lethal diabetic ketoacidosis (43.5%), three of eight cases of fatal hyperglycemic nonketotic coma (37.5%), and in two of five cases of alcoholic ketoacidosis (40%). Histologic examination revealed basal vacuolization of renal tubular epithelial cells in 12 cases, Armanni-Ebstein lesions in 10, and osmotic nephrosis in three. Although renal cortical pallor did not appear to be a particularly sensitive marker for hyperglycemia or ketoacidosis, and did not correlate with the severity of these parameters, it may still represent a useful macroscopic marker for underlying metabolic conditions at autopsy and should therefore prompt measurement of vitreous humor glucose and β-hydroxybutyrate levels.
authors.affiliation: School of Medical Sciences, The University of Adelaide Medical School, Frome Road, Adelaide, SA, 5005, Australia.
authors.forename: Chong
authors.initials: C
authors.lastname: Zhou
authors.forename: Andrea
authors.initials: A
authors.lastname: Yool
authors.forename: Roger W
authors.initials: RW
authors.lastname: Byard
mesh_terms: D020155:3-Hydroxybutyric Acid / Q000032:analysis; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D004847:Epithelial Cells / Q000473:pathology; D005260:Female; D049429:Forensic Pathology; D005947:Glucose / Q000032:analysis; D006801:Humans; D006944:Hyperglycemic Hyperosmolar Nonketotic Coma / Q000175:diagnosis*; D007662:Ketosis / Q000175:diagnosis*; D007672:Kidney Cortex / Q000473:pathology*; D007684:Kidney Tubules / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010167:Pallor / Q000473:pathology*; D014617:Vacuoles / Q000473:pathology; D014822:Vitreous Body / Q000737:chemistry; D055815:Young Adult
chemical_list: D015415:Biomarkers; D005947:Glucose; D020155:3-Hydroxybutyric Acid