Causes and renal morphological changes in chronic renal failure: a retrospective study of 50 autopsy cases

Abstract

The paper aims to determine the age and sex distribution of patients with end stage renal disease in Benin City, Nigeria, to study renal changes in chronic renal failure and determine where possible the causal/associated aetiopathologic agents in relation to chronic renal failure, and to compare results with those of similar studies done in other parts of the country. Complete autopsy was carried out on bodies of 50 patients who died of chronic renal failure at the University of Benin Teaching Hospital Benin City, after securing informed consent from the relatives. The kidneys were measured, weighed and described. In addition tissue samples were taken for histology using haematoxylin and eosin stain and the slides were subsequently read. Periodic acid Schiff and Masson’s Trichrome stains were applied to kidneys to address unresolved cases. All cases of acute renal failure due to shock were excluded from the study. As an inclusive criterion all cases used for the study were confirmed chronic renal failure patients who had been on dialysis for at least a period of 6 months and they all had a renal biopsy with histological confirmation of the type of renal lesions involved. Ethical approval was sought and granted by relevant authorities in UBTH before the study commenced in 2004. Twenty nine of the patients (58%) are males, 21 (42%) are females, with a male to female ratio of 1.38:1. The largest concentration of chronic renal failure (CRF) related deaths occurred in the 30-39 years 18 (36%), with the age range varying from 8 years in a male child who died of Good Pastures syndrome, to a 65 year old woman dying of chronic hypertensive renal disease. The average age of patients dying CRF is 43.9 years SD 6.6. Adult polycystic kidney disease is responsible for 2 deaths (4%), Systemic lupus erythematosus one death (2%). Chronic glomerulonephritis is responsible for 21 deaths (42%), the most significant cause of both end stage kidney disease and CRF. Diabetic nephropathy is responsible for 7 deaths (14%); hypertension is responsible for 15 cases (30%). Chronic renal failure related deaths in Benin City have a slight male preponderance of 1.38:1, and occurred in the average age group of 43.9 years SD 6.6. The commonest causes here include chronic glomerulonephritis accounting for 42%; hypertension, 30% and Diabetic Mellitus, 14% of cases. Key words: Chronic renal failure, changes, autopsy, retrospective study.