Kocovski Linda, Duflou Johan
Central Clinical School, University of Sydney, Sydney, NSW 2006, Australia.
J Forensic Sci. 2009 Mar;54(2):439-42. doi: 10.1111/j.1556-4029.2008.00956.x.
We investigate the morphological characteristics that may differentiate between ischemic acute tubular necrosis (ATN) and autolysis in postmortem samples. Renal tissue from 57 postmortem cases with an antemortem diagnosis of ATN and 57 age-/sex-matched control cases were examined for 10 morphological characteristics: epithelial proliferation (Ki-67 immunoperoxidase positivity), fibrin thrombi, tubular epithelial whorls, mitoses, casts, autolysis, tubulorrhexis, epithelial flattening, interstitial inflammation, and interstitial expansion. Tubular epithelial whorls were found in 16 ATN cases and were absent in controls. These findings suggest that specific morphological criteria may distinguish ischemic ATN from autolysis. Diagnoses of ATN may be confirmed using these combined criteria as contributing to cause of death and/or to ascertain previously undiagnosed cases of ATN postmortem.
我们研究了在尸检样本中可能区分缺血性急性肾小管坏死（ATN）和自溶的形态学特征。对57例生前诊断为ATN的尸检病例以及57例年龄和性别匹配的对照病例的肾组织进行了10种形态学特征检查：上皮细胞增殖（Ki-67免疫过氧化物酶阳性）、纤维蛋白血栓、肾小管上皮漩涡、有丝分裂、管型、自溶、肾小管破裂、上皮细胞扁平、间质炎症和间质扩张。在16例ATN病例中发现了肾小管上皮漩涡，而对照病例中未发现。这些发现表明，特定的形态学标准可能有助于区分缺血性ATN和自溶。使用这些综合标准有助于确定死因和/或查明生前未诊断的ATN病例，从而确诊ATN。
