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



• 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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