End-stage kidney

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.

Microscopic

Features:

• Global sclerosis of the glomeruli.
• Interstitial fibrosis.
• +/-Thyroidization - colloid-like hyaline cast formation that impart an appearance that mimics the thyroid gland:
  • Typical of chronic pyelonephritis and obstructive nephropathy.
• +/-Interstitial nephritis.
• +/-Pyelonephritis.

Note:

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

DDx:

• Diabetic nephropathy - most common cause of ESRD in North America, may have vague nodularity.
• Chronic pyelonephritis - commonly associated with ESRD.
• Renal papillary adenoma - common incidental finding.
• Acquired cystic disease of the kidney - seen in ESRD, may be an concurrent pathology.
• Other causes of end-stage renal disease.

Images

www:

• Thyroidization of the kidney (utah.edu).

Case 1

• 

  ESK - low mag. (WC)

• 

  ESK - intermed. mag. (WC)

• 

  ESK - low mag. (WC)

• 

  ESK - intermed. mag. (WC)

• 

  ESK - intermed. mag. (WC)

• 

  ESK - high mag. (WC)

Case 2

• 

  TK - low mag.

• 

  TK - intermed. mag.

• 

  TK - high mag.

• 

  TK - very high mag.

• 

  TK - very high mag.

Sign out

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

• Medical kidney diseases.
• Kidney.
• Acquired cystic disease-associated renal cell carcinoma.