End-stage kidney

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End-stage kidney
Diagnosis in short

End-stage kidney with thyroidization. H&E stain.

LM global sclerosis of the glomeruli, interstitial fibrosis, +/-thyroidization (colloid-like hyaline cast formation that impart an appearance that mimics the thyroid gland)
Gross small kidneys, thinned renal cortex, +/-dilated renal calyces, +/-cysts
Site kidney - see medical kidney diseases

Associated Dx chronic pyelonephritis, acquired cystic disease-associated renal cell carcinoma‎, papillary renal cell carcinoma, acquired renal cystic disease
Clinical history +/-diabetes mellitus (most common)

End-stage kidney, abbreviated ESK, is a non-functional (chronically damaged) kidney.

End-stage renal disease (abbreviated ESRD) and end-stage kidney disease (abbreviated ESKD) redirect here.

General

  • Many end-stage renal disease (ESRD) kidneys have a similar appearance.
    • Notable exception: polycystic kidney diseases have distinctive appearance, e.g. ADPKD.

Gross

  • Small kidneys.
  • Thinned renal cortex.
  • +/-Dilated renal calyces.
  • +/-Cysts.

Note:

  • Normal (adult) kidneys are ~11 cm from pole-to-pole.[1]

Microscopic

Features:

Note:

  • The end-stage kidney, much like the end-stage liver, often does not have apparent disease specific findings.

DDx:

Images

www:

Case 1

Case 2

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Right Kidney, Nephrectomy:
     - End-stage kidney with predominantly obsolete glomeruli, thyroidization and 
       chronic interstitial inflammation.
     - Minimal chronic inflammation of renal pelvis and ureter.
     - NEGATIVE for malignancy.

Block letters

KIDNEY, LEFT, NEPHRECTOMY:
- END-STAGE KIDNEY WITH MULTIPLE ABSCESSES ASSOCIATED WITH GIANT CELLS 
  AND HISTIOCYTIC RESPONSE.
- CHRONIC PYELONEPHRITIS AND INTERSTITIAL NEPHRITIS.
- ATHEROSCLEROSIS, MILD-TO-MODERATE.
- NEGATIVE FOR MALIGNANCY.

See also

References

  1. Glodny, B.; Unterholzner, V.; Taferner, B.; Hofmann, KJ.; Rehder, P.; Strasak, A.; Petersen, J. (2009). "Normal kidney size and its influencing factors - a 64-slice MDCT study of 1.040 asymptomatic patients.". BMC Urol 9: 19. doi:10.1186/1471-2490-9-19. PMID 20030823.
  2. Ito, S.; Kobayashi, A.; Tsuchiya, T.; Moriyama, Y.; Kikuchi, M.; Deguchi, T.; Yamaguchi, Y. (Aug 2009). "Thyroidization in renal allografts.". Clin Transplant 23 Suppl 20: 6-9. doi:10.1111/j.1399-0012.2009.01001.x. PMID 19594588.