Identification of the Armanni-Ebstein phenomenon in the kidneys can be a clue to fatal diabetic ketoacidosis (DKA).
Features of Armanni-Ebstein phenomenon:
(1) bilateral diffuse renal cortical pallor
(2) presence of numerous subnuclear vacuoles in the proximal convoluted tubules and/or the loop of Henle
where:
• Subnuclear vacuoles are located between the basement membrane and nucleus.
• The vacuoles were initially thought to contain glycogen (glycogen nephropathy). Now the vacuoles are thought to contain triglycerides and/or other lipids.
The presence of Armanni-Ebstein phenomenon is not diagnostic of diabetic ketoacidosis. Confirming the diagnosis of DKA requires measurement of glucose, lactic acid and ketoacids such as betahydroxybutyrate..
Differential diagnosis:
(1) hypothermia
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