Armanni-Ebstein lesions of the kidney: diagnostic of death in diabetic coma?

Section: Discussionmentioning

confidence: 99%

“…Measurement of these substances at autopsy provides the basis for the diagnosis of ketoacidosis post-mortem. Another clue to the presence of ketoacidoisis is the Armanni-Ebstein lesion, which consists of subnuclear vacuolation and has been principally described in diabetics with the vacuoles shown to contain fat [2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Armanni-Ebstein lesion, ketoacidosis and starvation in a child

Milroy

Parai

2011

“…The lesion consists of subnuclear vacuolation of the proximal tubules of the kidneys. Previous studies reported the vacuoles contained glycogen, more recent work shows that the vacuoles contain fat [2][3][4]. Diabetic ketoacidosis has long been associated with the Armanni-Ebstein lesion, Thomsen and colleagues reported fat in the kidneys in alcoholics [5] and Milroy and Parai reported a case of Armanni-Ebstein lesion in a non-diabetic child with ketoacidosis associated with starvation [6].…”

Section: Introductionmentioning

confidence: 98%

Alcoholism and the Armanni–Ebstein lesion

Parai

Kodikara

Milroy

et al. 2011

The Armanni-Ebstein lesion is a histological change in the kidney consisting of sub-nuclear vacuolation of the proximal tubules. It has been most associated with diabetic ketoacidosis. The vacuoles have been reported to contain glycogen. More recent studies show them to contain fat. Recent papers have associated the Armanni-Ebstein lesion with non-diabetic ketoacidosis. We present 11 cases of alcoholic ketoacidosis where the Armanni-Ebstein lesion was identified. None had a history of diabetes mellitus and none showed any changes of diabetic nephropathy. All 11 cases had raised acetone levels (3-67 mg/100 mL (mean 17.9 mg/100 mL and median value of 16 mg/100 mL). In addition a case of isopropanol poisoning was found to have the Armanni-Ebstein lesion. Isopropanol is converted to acetone but is not associated with acidosis. These results indicate that the Armanni-Ebstein lesion is not specific to diabetes mellitus.

“…Although usually localized to the nephron and principally involving the terminal straight portion of the proximal tubule, the phenomenon may also involve the descending and ascending limbs of the loop of Henle [2]. While earlier studies attributed this effect to cytoplasmic glycogen accumulation following excess reabsorption of glucose in the antemortem period immediately before death [3], later studies have suggested that the vacuoles contain triglycerides/lipids [4,5].…”

Section: Further Autopsy Findings and Diagnosismentioning

confidence: 99%

Early diagnosis of Armanni–Ebstein phenomenon at autopsy

Zhou

Gilbert

Byard

2010

A 41-year-old woman with a past history of insulindependent diabetes mellitus, intravenous drug use and asthma was found collapsed and unresponsive at her home address. Her history also included previous hospital admissions with diabetic ketoacidosis. She was conveyed by ambulance to hospital, where she was found to be unconscious, hypotensive and acidotic with a markedly elevated blood glucose level. Resuscitative efforts were unsuccessful.At autopsy, the most significant finding was of marked pallor of both renal cortices on cut section (Fig. 1). Other findings included pulmonary edema with evidence of recent attempts at resuscitation. Fig. 1 Marked pallor of the renal cortex in a 41-year-old woman presenting to hospital unconscious