Incidental Renal Disorders Found at Necropsies of Violent Death Victims

Abstract

Background: The burden of CKD in our environment remains high while biopsy uptake is low, making for high level of uncertainty in the morphologic characterization of renal disorders. Aim: To evaluate kidney necropsy tissues of violent death victims, asymptomatic of renal disorders, with a view to detecting lesions of clinical interest and determining the morphologic features of such lesions. Also to review the literature for silent conditions that advances the course of CKD. Materials and Methods: Prospective cohort study carried out on kidney necropsy tissues of violent death victims who in their antemortem states were asymptomatic of renal disorders. Subjects were firearm and road traffic accident victims irrespective of gender and age brought to UPTH morgue in January 2017, whose close relatives consented. Information confirming that decedents were asymptomatic of a renal disorder was obtained from deceased’s close relatives. Necropsy tissues were processed using standard operating procedures for histopathology of renal biopsies, and slides were read by the authors using light microscopy only. Results: Forty-three tissues were collected-41 males and 2 females. Mean and peak ages were 29.3 (4.9) and 21-30 years with 25/43 (58.1%). Twenty cases (46.5%) showed glomerular pathologies composed of 18.6% FSGS and 27.9% MPGN. Twenty three cases (53.5%) were devoid of histologic evidence of glomerular injury. All cases showed evidence of variable degrees of acute tubular injury with ten cases (23.3%) showing PAS positive casts. Four cases (two each from FSGS and MPGN) displayed chronic interstitial nephritis with mild fibrosis. There was thickening of the arteriolar tunica media in 12 bodies (27.9%). Conclusion: Prevalence of asymptomatic CKD is very high among the youths of our locality. Glomerular lesions constitute common pathogenetic bases unlike tubulointerstitial and vascular lesions which were uncommon. Enunciating measures that targeted the youths aimed at reducing rate of smoking and abuse of common analgesics like paracetamol as well as measures that will improve the overall socioeconomic status and encourage routine medical examinations may reverse the upward trend of asymptomatic CKD among our youths.