Subnuclear renal tubular vacuoles in alcohol use disorder.
Armanni-Ebstein lesion
alcohol use disorder
alcoholic ketoacidosis
autopsy
betahydroxybutyrate
forensic pathology
renal tubular vacuolization
steatosis
subnuclear vacuolation
Journal
Journal of forensic sciences
ISSN: 1556-4029
Titre abrégé: J Forensic Sci
Pays: United States
ID NLM: 0375370
Informations de publication
Date de publication:
Sep 2023
Sep 2023
Historique:
revised:
15
06
2023
received:
26
03
2023
accepted:
16
06
2023
medline:
6
9
2023
pubmed:
6
7
2023
entrez:
6
7
2023
Statut:
ppublish
Résumé
Subnuclear vacuoles in the proximal renal tubules have been reported as a histologic sign of ketoacidosis. Originally described in diabetic ketoacidosis, renal vacuoles can be found in other ketogenic states such as alcoholic ketoacidosis (AKA), starvation, and hypothermia, underpinned by deranged fatty acid metabolism. A retrospective analysis of 133 deaths associated with alcohol use disorder (AUD) examined at autopsy between 2017 and 2020 was undertaken. This study aimed to determine the prevalence of subnuclear vacuoles in deaths of those with AUD and their specificity for deaths from AKA, and to elucidate what demographic, biochemical, and pathologic findings are associated with subnuclear vacuoles. In each case, vitreous humor biochemistry including electrolytes, glucose, and beta-hydroxybutyrate (BHB) was analyzed alongside postmortem hemoglobin A1c and renal and liver histology. Renal histology was graded for the presence of vacuoles as absent (0), scanty (1), or easily identifiable (2). Liver histology was graded for steatosis and for fibrosis if Masson trichrome staining was available. Vacuoles were commonly seen in the deaths of those with AUD. They were seen in deaths due to AKA but were not specific to that cause of death. With vacuoles present, lower vitreous sodium (139 vs. 142 mmol/L; p = 0.005), higher vitreous BHB (1.50 vs. 1.39 mmol/L; p = 0.04), severe hepatic steatosis, and severe hepatic fibrosis were seen, compared with those without renal vacuoles.
Identifiants
pubmed: 37409637
doi: 10.1111/1556-4029.15321
doi:
Substances chimiques
3-Hydroxybutyric Acid
TZP1275679
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1759-1767Informations de copyright
© 2023 The Authors. Journal of Forensic Sciences published by Wiley Periodicals LLC on behalf of American Academy of Forensic Sciences.
Références
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