HISTOMORPHOLOGICAL SPECTRUM OF LIVER AND KIDNEY LESIONS IN AUTOPSY CASES

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INTRODUCTION
Autopsy helps to identify organ pathology and determines the cause and time of death.It is also beneficial to study both the ante-mortem and postmortem aspects of death [1].Autopsies contribute to pathology knowledge by revealing rare lesions that are a source of learning from a pathologist's perspective.Autopsies also aid in detecting various incidental lesions that would otherwise go unnoticed during a person's life [2,3].It is also helpful for retrospective quality assessment of clinical diagnoses and as an educational tool for clinicians [4].Microscopic examination is exceedingly advantageous for studying the disease process [5].
The liver is involved in a variety of inflammatory, neoplastic, and other lesions like metabolic, toxic, microbial, and circulatory insults.In some cases, the disease is primary, whereas, in others, the involvement of the liver is secondary to cardiac decompensation, alcoholism, or extrahepatic infections [6][7][8].Even in advanced stages, most chronic liver diseases have no obvious clinical signs or symptoms.They either go undiagnosed or are discovered by chance during routine health checks, investigations for other diseases, surgery, or autopsies [9][10][11].
Kidney biopsy is usually avoided in critically ill patients; hence, histologic evaluation of autopsy specimen may be the first and only chance to study and diagnose these diseases [12,13].Kidney functions may be harmed by the following conditions: (a) Obstructive and vascular diseases, (b) infections and inflammatory diseases, (c) interstitial diseases, (d) cystic diseases, (e) neoplasms, and so on [14].
Histologic examination of kidneys at autopsy can aid in the identifying renal lesions and discovering rare lesions [15].Autopsy cases have revealed a wide range of renal pathology, including diabetic nephropathy, chronic pyelonephritis, acute tubular necrosis, chronic glomerulonephritis, tuberculous inflammation, and many others [16].The rise in the prevalence of kidney diseases is due to the accumulation of risk factors such as hypertension, diabetes, dyslipidemia, and obesity [17].The present study was carried out to evaluate various gross and histopathological findings All the specimens were fixed in 10% formalin, weight and dimensions were recorded.After tissue processing, paraffin blocks sections were studied from liver and kidney specimens.The Histological sections were prepared and stained using H and E Stain.Microscopic examination was done and finding was recorded.
The study was conducted after obtaining the permission from ethical committee.Collected data were entered in the MS Excel spreadsheet, coded appropriately, and later cleaned for any possible errors.The statistical analysis was carried out using appropriate statistical software.

RESULTS
Out of the 230 cases evaluated in the present study, 168 specimens of liver and 127 specimens of kidney were evaluated.Liver specimens were from 126 males and 42 females.Kidney specimens were from 99 males and 28 females.Age group of 41-60 years was found to be most common in both liver and kidney cases (Fig. 1).On histomorphological evaluation of liver specimens, most common finding was steatosis (36.9%) followed by congestion (22.6%).Granulomatous lesions and metastasis were incidental finding in liver specimens (Table 1).
On histomorphological evaluation of kidney specimens, most common finding was vascular lesions (38.6%) followed by tubular/interstitial lesions (32.3%).We found simple renal cyst in a case of renal autopsy (Table 2 and Fig. 2).

DISCUSSION
The term autopsy is derived from Greek and it means auto (oneself) and opsis (eye) which is "to see for self."Autopsy helps identify pathologies occurring in the organ and determine the cause and time of death.It is also advantageous to study both the ante-mortem and postmortem aspects of death.In the present study, we evaluated 230 cases.168 specimens of liver and 127 specimens of kidney were evaluated.Liver specimens were from 126 males and 42 females.Kidney in the liver and kidney and to determine the spectrum of liver and kidney diseases among medicolegal autopsy cases.
specimens were from 99 males and 28 females.Forty-one-60 years of age group was found to be most common.
In the present study, we observed steatosis as most common liver lesion which correlated with other studies by Singh et al. and Devi et al. [18,19].We observed vascular lesion as most common kidney lesion which was similar to the other studies.
In a study conducted by  5).

CONCLUSION
Histopathological study of liver and renal autopsy specimens helps in establishing the cause of death and also detects incidental lesions.It also acts as magnificent learning tool for pathologist.We concluded that most common findings are fatty liver and vascular lesions in liver and kidney respectively.Hence, this study highlights the importance of autopsy histopathology of liver and kidney specimens.

Table 4 )
Selvi et al., they found steatosis as most common liver pathology in liver autopsy specimens.In a study conducted by Umesh et al., they found steatosis as most common liver lesions accounting for 22.90%.In another study conducted by Patel et al., they found that 56% of specimens have normal histology followed by 36% of specimens had steatosis.In Studies conducted by Smita et al. and Alagarsamy et al., they found congestion as most common lesion compared to steatosis [20].In a study conducted by Madhubala et al., liver cirrhosis is found to be most common.Porwal et al. concluded that congestion is most common lesion followed by steatosis.Moreover, a study conducted by Kulkarni et al., they concluded steatosis as most common lesion in liver autopsy specimen (Table 3). .In the present study, we found that males cases are more than female cases.Similar gender distribution showing males more than female is found in various other studies like studies conducted by Amandeep et al., Vaneet et al., Desai et al., Khare et al., Neha et al., Selvi et al., Umesh et al., Patel et al., Smita et al., Kataria et al., Kulkarni et al., and Porwal et al.Hence, all of the studies found male autopsy more than female autopsy.The present study has 41-60 years age group as most common which is correlating with other studies like study conducted by Neha et al. (Table