Basal vacuolization of renal tubules in hypothermia: A comprehensive pathological study based on 79 forensic autopsy cases

IF 2.2 3区 医学 Q1 MEDICINE, LEGAL Forensic science international Pub Date : 2024-10-29 DOI:10.1016/j.forsciint.2024.112277
Shojiro Ichimata, Yukiko Hata, Naoki Nishida
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Abstract

This study investigated the usefulness of histopathological examination in diagnosing ketoacidosis in hypothermia cases. Out of 79 cases (38 females), 30 showed basal vacuolization (BV), a representative histopathological finding of ketoacidosis, in their hematoxylin and eosin (H&E)-stained specimens. Through the use of both lipid staining with osmium tetroxide postfixation and immunohistochemistry for adipophilin (ADFP-IHC), BV pattern pathology was identified in 43 cases. Serum was available in 75 cases, with 37 having serum β-hydroxybutyrate levels exceeding 1000 μmol/L. Serum β-hydroxybutyrate concentrations showed a significantly negative correlation with age and tended to be lower in outdoor hypothermia cases than in indoor cases. When comparing serum β-hydroxybutyrate levels with histopathological findings, all but one of the BV-positive cases on H&E staining were serologically diagnosed as ketoacidosis. However, when combining multiple staining methods, six cases were histologically positive but serologically negative. Using multiple staining methods increases BV detection sensitivity, but it may also detect findings of unknown pathological significance. Therefore, identifying a distinct BV pattern in H&E-stained specimens is crucial for suspecting ketoacidosis in the usual practice of forensic pathology, and ADFP-IHC is useful for confirming lipid droplet presence. Our results suggest that BV positivity rates are strongly influenced by the case characteristics of the study cohort, particularly the proportion of older adults. Thus, the extent to which BV is complicated by hypothermia should be examined and understood on a country-by-country or region-by-region basis.
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低体温时肾小管基底空泡化:基于 79 例法医尸检的综合病理研究
本研究探讨了组织病理学检查在诊断低体温病例酮症酸中毒中的作用。在 79 例病例(38 例女性)中,有 30 例在苏木精和伊红(H&E)染色的标本中显示出基底空泡化(BV),这是酮症酸中毒的代表性组织病理学发现。通过使用四氧化锇后固定脂质染色法和嗜脂素免疫组化法(ADFP-IHC),在 43 例病例中确定了 BV 模式病理。有 75 例病例的血清可用,其中 37 例的血清 β-羟基丁酸水平超过 1000 μmol/L。血清中的β-羟丁酸浓度与年龄呈显著负相关,室外低体温病例的β-羟丁酸浓度往往低于室内病例。将血清中的β-羟丁酸水平与组织病理学结果进行比较时,除一例 H&E 染色的 BV 阳性病例外,其他病例均被血清学诊断为酮症酸中毒。然而,在结合多种染色方法后,有六个病例的组织学结果为阳性,但血清学结果为阴性。使用多种染色方法可提高 BV 检测的灵敏度,但也可能检测出病理意义不明的结果。因此,在通常的法医病理学实践中,在 H&E 染色标本中鉴别出独特的 BV 模式是怀疑酮症酸中毒的关键,而 ADFP-IHC 则有助于确认脂滴的存在。我们的研究结果表明,BV 阳性率受研究队列中病例特征的影响很大,尤其是老年人的比例。因此,应根据各国或各地区的具体情况来研究和了解低体温在多大程度上使 BV 变得复杂。
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来源期刊
Forensic science international
Forensic science international 医学-医学:法
CiteScore
5.00
自引率
9.10%
发文量
285
审稿时长
49 days
期刊介绍: Forensic Science International is the flagship journal in the prestigious Forensic Science International family, publishing the most innovative, cutting-edge, and influential contributions across the forensic sciences. Fields include: forensic pathology and histochemistry, chemistry, biochemistry and toxicology, biology, serology, odontology, psychiatry, anthropology, digital forensics, the physical sciences, firearms, and document examination, as well as investigations of value to public health in its broadest sense, and the important marginal area where science and medicine interact with the law. The journal publishes: Case Reports Commentaries Letters to the Editor Original Research Papers (Regular Papers) Rapid Communications Review Articles Technical Notes.
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