title: Basal Vacuolization in Renal Tubular Epithelial Cells at Autopsy and Their Relation to Ketoacidosis.
abstract: Basal vacuolization of renal tubular epithelial cells is a useful postmortem marker for ketoacidosis. To investigate its incidence and relationship to the severity of ketoacidosis, 158 autopsy cases with elevated β-hydroxybutyrate (>1 mmol/L) over a 7-year-period were retrospectively reviewed. Sixty-eight cases (43%) exhibited basal vacuolizations (vitreous β-hydroxybutyrate: 1.16-29.35 mmol/L, mean 10.28 mmol/L), and 90 cases (57%) did not (vitreous β-hydroxybutyrate: 1.03-13.7 mmol/L, mean 2.84 mmol/L). Quantitative analysis revealed on average a fourfold elevation in β-hydroxybutyrate in cases with basal vacuolizations compared to those without; 10.3% of cases with β-hydroxybutyrate concentrations between 1.01 and 2.00 mmol/L had basal vacuolizations, and this incidence increased to 33.3% with concentrations between 4.01 and 6.00 mmol/L. A marked increase in incidence to >70% was observed with concentrations >6.00 mmol/L, and basal vacuoles were invariably present (100%) with concentrations >14.01 mmol/L. This study demonstrates that basal vacuolizations are a sensitive marker for significant ketoacidosis and reaffirms its use as an indicator for likely cases of fatal ketoacidosis at autopsy.
authors.affiliation: School of Medicine, The University of Adelaide, Frome Road, Adelaide, SA, 5005, Australia.|Forensic Science SA, 21 Divett Place, Adelaide, SA, 5000, Australia.
authors.forename: Chong
authors.initials: C
authors.lastname: Zhou
authors.affiliation: School of Medicine, The University of Adelaide, Frome Road, Adelaide, SA, 5005, Australia.
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: Yool
authors.affiliation: School of Medicine, The University of Adelaide, Frome Road, Adelaide, SA, 5005, Australia.|Forensic Science SA, 21 Divett Place, Adelaide, SA, 5000, Australia.
authors.forename: Roger W
authors.initials: RW
authors.lastname: Byard
mesh_terms: D020155:3-Hydroxybutyric Acid / Q000378:metabolism; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D004847:Epithelial Cells / Q000473:pathology*; D005260:Female; D049429:Forensic Pathology; D005947:Glucose / Q000378:metabolism; D006801:Humans; D007662:Ketosis / Q000175:diagnosis*; D007684:Kidney Tubules / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014617:Vacuoles / Q000473:pathology*; D014822:Vitreous Body / Q000378:metabolism; D055815:Young Adult
chemical_list: D015415:Biomarkers; D005947:Glucose; D020155:3-Hydroxybutyric Acid
keywords: alcoholic ketoacidosis; basal vacuolization; diabetes mellitus; diabetic ketoacidosis; forensic science; septic ketoacidosis; starvation ketoacidosis