Chronic renal failure: An autopsy study.

Diabetes and hypertension are at present the major causes of chronic kidney disease (CKD) and end-stage renal disease (ESRD) worldwide. The stages 0-5 of CKD are defined according to the estimated glomerular filtration rate. The term chronic renal failure (CRF) typically corresponds to CKD stages 3-5. Cardiovascular disease is the main cause of morbidity and mortality in patients of CRF and ESRD. This study was undertaken to analyze the age and sex incidence, clinical features, etiology, pathology of various organs in detail, and causes of death of CRF patients. All autopsies performed on known cases of CRF and those who were diagnosed as CRF at autopsy at a tertiary care hospital in India over a 7-year period were studied. The highest number of cases of CRF fell within the 56-65 years age group with a male/female ratio of 1.38:1. Oliguria and anasarca were the most common presenting features. Chronic pyelonephritis was the most common cause of CRF in our study, followed by hypertension, diabetes, and chronic glomerulonephritis. Other causes included amyloidosis, autosomal poly- cystic kidney disease, and ischemic and multiple myeloma. Most common cause of death found was cardiovascular, followed by infections, cerebrovascular, metabolic, and other causes.

Clinical, morphological, immunological correlation of kidney biopsies and prognostication.

Twenty seven ANA and dsDNA positive cases were selected from surgical files from years 1986 to 1997. Clinical, biochemical, morphological and immunofluorescence findings were correlated. Routine Haematoxylin and Eosin, Per iodic-Acid-Schiff and Methaneamine-Silver stains were used for all cases. Direct immunofluorescence was done whenever possible. Morphologically cases were grouped as per WHO criteria. Morphologically cases were quantified into Austin's chronicity and activity indices. Twenty one to thirty years was common age group. M:F:: 1:4.4. Anemia, skin rash and arthralgia were common extra-renal manifestations. There were 1,5,7,10 and three cases as per WHO class I to V respectively. All cases of class IV had active urine sediments and proteinuria. Four cases had high BUN and Serum creatinine levels. All (12) cases of immunofluorescence revealed group specific patterns. Five cases died. Infection was common cause of death. Twenty to thirty years, males, High BUN and Creatinine levels and high activity and chronicity indices were associated with poor prognosis.

Primary adenocarcinoma of the urinary bladder: a study of 6 cases from the pathologist's point of view.

OBJECTIVE: The clinical presentation of adenocarcinoma is not different from the usual transitional cell carcinoma, hence the histological diagnosis plays an important role in the interpretation of cystoscopic biopsies. Six cases of primary adenocarcinoma of the urinary bladder are described from the pathologist's point of view. The diagnostic problems encountered in these cases are highlighted. METHODS: 6 cases of primary adenocarcinoma of the urinary bladder were encountered from 1983 to 1997. Relevant clinical data were analyzed. Multiple sections from the tumor and adjoining areas of the bladder were studied. Five patients were aged 50 to 75 years and the youngest patient was 22 years old. RESULTS: Hematuria and retention of urine were common presenting symptoms. Histologically, the diagnostic problems faced were mucinous metaplasia vs mucinous carcinoma, clear cell adenocarcinoma of the urinary bladder vs clear cell carcinoma of the pelvic kidney. We had one case of urachal and 5 cases of non-urachal carcinoma. CONCLUSIONS: Primary adenocarcinoma of the urinary bladder is an unusual tumor accounting for 0.5 to 2% of all bladder malignancies. They are commonly seen in endemic areas like schistosomiasis. By origin they are grouped into urachal and non-urachal carcinoma and histologically grouped as enteric, mucinous, clear cell and adenocarcinoma not otherwise specified. Direct consultation with the urologist, clinical findings, investigations and careful screening of histological material will help the pathologist to arrive at a correct diagnosis.