Renal Lesions At Autopsy Among Adults At Mulago Hospital Over A Five Year Period (2009-2013)

Abstract

Introduction Autopsy is one of the techniques that can be utilized to study disease that didn’t present any suggestive features in life or that was not fully studied in life, and kidney diseases fall in those diseases which are commonly diagnosed at autopsy. Chronic kidney disease (CKD) is a common condition that refers to a long-term loss of kidney function and it comprises a group of pathologies in which the renal excretory function is chronically compromised, mainly resulting from damage to renal structures. The disease may start in the tubules and interstitium, or in the glomeruli or even in the renal vascular tree. Renal lesions commonly seen at autopsy may be classified under broad groups including among others: glomerular lesions, tubular lesions, interstitial and vascular lesions. Objective This study aimed at describing renal lesions seen at autopsy among adults at Mulago Hospital Mortuary over a five-year period (2009-2013) and relating them to patient characteristics. Methods This was a cross sectional study, in which 181 cases of formalin-fixed paraffin waxembedded tissue blocks from clinical post-mortem examinations were retrieved from the archives of the Department of Pathology. Haematoxylin and Eosin (H& E), Masson’s trichrome, Jones Methamine Silver, Periodic Aid Schiff and Congo red stained sections of the kidney tissues were evaluated. Histological findings were reported. Results: A total of 181 cases formed the study sample, 102 (56%) were male and 79 (44%) were female. The median age of the study cases was 46.4±18.3 years. In total, 82.9% of the x cases showed abnormal kidney histology, with all cases in the age group 56 and above showing abnormalities. The interstitium was the region most commonly affected by lesions (80.1%) with the commonest lesion being interstitial fibrosis (41.4%) followed by chronic interstitial nephritis. Glomerular lesions were found in 67.9% of cases with focal segmental glomerulosclerosis (FSGS) (29.8%) as the most common lesion. Benign hypertensive nephrosclerosis was found in 30.4% cases. There was positive association between FSGS and HIV infection, p= 0.02. There was a positive association between benign hypertensive nephrosclerosis and a clinical history of hypertension, p= 0.00. There was also a positive association between benign hypertensive nephrosclerosis and age group 56-75 years, p= 0.004 and over 75 years of age, p= 0.001. Conclusion: Renal lesions were quite frequent at autopsy suggesting that it’s a frequent cause of morbidity. This calls for screening of high risk groups identified like hypertensives and those infected with HIV for timely interventions that halt or slow progress of chronic kidney disease.