CASE HISTORY

About 6 weeks before death the patient developed muscular pains, mainly in the legs. A few days later he developed an illness with malaise, shivering and general aching. There was anorexia followed by vomiting and pain. Shortly after this the urine was noted to be scanty and of a reddish colour and finally he ceased to pass urine. He was admitted to another hospital where he was found to have proteinuria and haematuria and a rising blood urea and he was transferred here for dialysis. Urine output after admission was extremely scanty and he was dialysed on two occasions but he finally died, mainly of chest infection.

PATHOLOGY

Kidney 185mmx155mmx60mm. The specimen consists of one half of a kidney. At autopsy the kidneys weighed approximately double normal and this mounted half kidney is obviously enlarged. Externally the capsule has stripped cleanly leaving a smooth surface but there is a hint of fine red speckling due actually to haemorrhage into glomerular tufts. On the cut surface the general architecture of the kidney is very well preserved; the cortex is of normal thickness, the junction is clear. There is some loss of  definition in the cortical pattern. There are tiny reddish spots of haemorrhage, as on the outer surface, but the appearances as a whole are not diagnostic though they are suggestive.