![\"\"](\"https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2024\/11\/6914.div_-scaled.jpg\")
<\/a><\/p>\nAnd here it is under polarization:<\/p>\n
Now, when you read the textbooks, they always say that the oxalate crystals look like “sheaves of wheat.”\u00a0 \u00a0I have two problems with that.\u00a0 The first is that I don’t know anybody younger than me who has ever seen an actual sheaf of wheat — and I only saw them as a kid in Halloween and Thanksgiving day displays.\u00a0 It’s one of those pathology tropes that nobody actually can connect to directly any more.\u00a0 Sorta like “bitter almond” smell in cyanide.\u00a0 \u00a0Who goes around smelling bitter almonds?\u00a0 Do they really stink?\u00a0 I wouldn’t know, having never seen one in my life.<\/p>\n The second is that they don’t really look like sheaves of wheat to me.\u00a0 \u00a0To me they are just irregular:<\/p>\n A fair number of them seem to have an OK “fan” or radiating feel:<\/p>\n But that double “sheaf” pattern, which is basically two of those fan shapes stuck together, is not that common in my experience.\u00a0 Don’t get me wrong, the shape is fairly distinctive — it’s not the needles or cubes or clumps you see with some other stuff.<\/p>\n Back when I was a tyke, oxalate nephropathy was not all that uncommon due to poisoning with ethylene glycol.\u00a0 I haven’t seen one of those cases in a decade.\u00a0 It used to be that someone would kill someone with ethylene glycol and get away with it for a few years.\u00a0 It worked so well that they’d start doing it again.\u00a0 In my cases, it was usually a woman who killed her husband, and then started disposing of lovers that way.\u00a0 Then she’d get caught, there’d be an exhumation or two, and it would be all over the papers.\u00a0 People would read the papers and say to themselves “Hey, that sounds like a great way to get rid of my asshole spouse!” and we’d have a rash of these things for a year or two.\u00a0 It would be on everybody’s mind, and folk would diligently look for the cases.\u00a0 I can remember as a young pathologist doing touch preps of kidneys so I’d catch them quickly. After a few months to year or so, it would die down, and you wouldn’t see any cases for four or five years or more.\u00a0 Then there’d be another spike.<\/p>\n I remember seeing the same pattern with arsenic poisoning as well.\u00a0 We used to train on trying to see arsenic effects in the liver and such.\u00a0 But that’s for another post — if I ever see one again.<\/p>\n No more.\u00a0 \u00a0I don’t think I’ve seen an ethylene glycol poisoning in over a decade.\u00a0 The last case that comes to mind was an alcoholic who found a bottle of “wine” in a landfill, but it turned out to be full of used antifreeze, and somebody had used an empty wine bottle to hold it after they’d flushed their radiator.\u00a0 I still check and find oxalate nephropathy now and then, but it’s all natural disease.\u00a0 I still polarize every case I get.\u00a0 I polarize the kidney to look for oxalate and other crystals, and I polarize the lungs to look for debris from intravenous drug use.\u00a0 And, I get a few hits now and then on both.\u00a0 It’s easy to do, it’s an easy diagnosis to pick up — these things aren’t subtle — and it only takes a second or two.<\/p>\n Nowadays, it’s wacky diets, bariatric surgery and other things that alter enteric absorption, and some chronic diseases such as chronic pancreatitis and diabetes mellitus (also likely because of enteric effects) that I see it in.\u00a0 \u00a0The crystals in these cases are not nearly as plentiful as in poisoning cases in my personal experience, but they are there.<\/p>\n So, here’s a take home question for you.\u00a0 There are three primary ways that drinking ethylene glycol can kill you.\u00a0 What are those mechanisms?<\/p>\n <\/p>\n","protected":false},"excerpt":{"rendered":" This is the kidney of the person with diabetic nephropathy I just posted about.\u00a0 In addition to Kimmelstiel-Wilson nodules, the…<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[99,109,60,1],"tags":[59,56,69],"class_list":["post-2138","post","type-post","status-publish","format-standard","hentry","category-forensic-pathology","category-pathology-cases","category-photomicrographs","category-uncategorized","tag-autopsy","tag-histology","tag-kidney"],"_links":{"self":[{"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/posts\/2138","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/comments?post=2138"}],"version-history":[{"count":5,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/posts\/2138\/revisions"}],"predecessor-version":[{"id":2154,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/posts\/2138\/revisions\/2154"}],"wp:attachment":[{"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/media?parent=2138"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/categories?post=2138"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/tags?post=2138"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}<\/a><\/p>\n<\/a> <\/a> <\/a><\/p>\n<\/a><\/p>\n<\/a> <\/a><\/p>\n