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Int J Clin Exp Pathol 2012;5(4):326-330

Original Article
Necrotic epithelial cells in proximal renal tubules of 2nd trimester fetuses: is this “acute
tubular necrosis”?

Luiz Cesar Peres, Chitra Sethuraman, Mudher Al-Adnani, Marta Cecilia Cohen

Department of Histopathology, Sheffield Children’s Hospital NHS Foundation Trust, Sheffield, S10 2TH, United Kingdom

Received January 20, 2012; accepted March 30, 2012; Epub April 16, 2012; Published May 30, 2012

Abstract: The aim of this study is to describe the occurrence of necrotic tubular cells in kidneys of non-macerated fetuses. Methods:
Description of histology and immunostaining results using C9 immunostain of proximal tubular epithelium of kidneys from 30 consecutive non-
macerated fetuses’ autopsies. Results: the gestational age ranged from 13 to 22 weeks. The mean gestational age was 18.6 weeks; the
cause of death was acute chorioamnionitis in 13 cases (43.3%), termination of pregnancy for fetal anomalies in 13 (43.3%) and other causes
in 4 (13.3%). Histology of the kidneys revealed vacuolation of proximal tubule epithelial cells (100%), dilatation of tubules (93.4%) and tubular
cell necrosis (53.4%). C9 immunostaining was positive in 24 cases (80%) and was seen in all gestational ages. Conclusions: These results
indicate that tubular cell necrosis is not an uncommon finding in the kidneys of 2nd trimester fetuses and may represent acute tubular necrosis
(ATN). C9 is a helpful marker in confirming this diagnosis. Future studies may further explore this preliminary observation.

Keywords: Fetus, C9, autopsy, hypoxic-ischemic lesion, kidney, tubular necrosis

Address all correspondence to:
L. Cesar Peres, MD, PhD
Department of Histopathology
Sheffield Children’s Hospital NHS Foundation Trust
Western Bank
Sheffield, U.K., S1 2EH
Tel: (+44 114) 226-0738
Fax: (+44 114) 271-7365
cesar.peres@sch.nhs.uk; l.cesar.peres@gmail.com