{"id":2909,"date":"2026-09-30T22:07:22","date_gmt":"2026-10-01T02:07:22","guid":{"rendered":"https:\/\/wordpress.forensicpath.us\/?p=2909"},"modified":"2026-09-30T22:07:22","modified_gmt":"2026-10-01T02:07:22","slug":"pathology-cases-proximal-tubule-simplification-in-acute-kidney-injury","status":"publish","type":"post","link":"https:\/\/wordpress.forensicpath.us\/index.php\/2026\/09\/30\/pathology-cases-proximal-tubule-simplification-in-acute-kidney-injury\/","title":{"rendered":"Pathology cases — Proximal tubule simplification in acute kidney injury"},"content":{"rendered":"

This is a case of a young man who had a long history of drug use who suffered a single vehicle car crash.\u00a0 He came to the ED with a large laceration that was stitched up.\u00a0 \u00a0He was given antibiotics and sent home.\u00a0 At home, he declined to take his antibiotics, but did take methamphetamine.\u00a0 A week and a half later he showed up to the ED again with fever, icterus, and purpura.\u00a0 He grew Staph. aureus from his blood.\u00a0 He declined rapidly with multiorgan failure and died.<\/p>\n

Examination of this kidneys revealed classic simplification and flattening of the proximal tubule epithelium with loss of brush border associated with acute kidney injury .\u00a0 Here’s a couple of pics:<\/p>\n

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You can see how the epithelial cells are flatter and have smooth apices.\u00a0 To remind you, here’s a couple of pics from a more normal case:<\/p>\n

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… and a side-by-side<\/p>\n

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Somewhere along the line, I saw this called “distalization” of the proximal tubules — because they start looking like distal tubules.\u00a0 However apparently, that’s not a real descriptor.\u00a0 Too bad.\u00a0 I kinda like it.<\/p>\n

I recently read an interesting article about this.\u00a0 It turns out that this change represents dedifferentiation of the proximal tubular cells into a more primitive form that can replicate.\u00a0 When the tubules are injured and have to fill in the empty spots left by dead cells, the remaining cells dedifferentiate and replicate rather than recruiting stem cells.\u00a0 Cool.\u00a0 See:<\/p>\n

https:\/\/www.pnas.org\/doi\/10.1073\/pnas.1310653110<\/a><\/p>\n

Also, of interest, it turns out that methamphetamine use is a risk factor tor cellulitis following injury.\u00a0 Turns out that meth makes recovery more difficult by two mechanisms.\u00a0 First, as expected, it is a vasoconstrictor that decreases blood flow to the injury.\u00a0 Second, it is a direct immunomodulator that iincreases IL-6 and decreases phagocytosis.\u00a0 \u00a0It also stimulates biiofilm formation. Who knew.<\/p>\n

https:\/\/journals.asm.org\/doi\/full\/10.1128\/mbio.01622-15<\/a><\/p>\n

As always, free for use with or without attribution, though attribution is always appreciated.\u00a0 If you need higher resolution images, contact me.<\/p>\n

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This is a case of a young man who had a long history of drug use who suffered a single…<\/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],"tags":[69],"class_list":["post-2909","post","type-post","status-publish","format-standard","hentry","category-forensic-pathology","category-pathology-cases","tag-kidney"],"_links":{"self":[{"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/posts\/2909","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=2909"}],"version-history":[{"count":2,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/posts\/2909\/revisions"}],"predecessor-version":[{"id":2916,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/posts\/2909\/revisions\/2916"}],"wp:attachment":[{"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/media?parent=2909"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/categories?post=2909"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/tags?post=2909"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}