Ketoacidosis may cause changes in the renal tubular epithelium.

Changes in the renal tubular epithelium associated with ketoacidosis:

(1) basal (subnuclear) vacuolization

(2) formalin pigment deposition adjacent to basal vacuoles (in about 50% of cases)


The changes are not specific for the cause of the ketoacidosis (diabetes, alcohol, sepsis, starvation, etc). The more severe the ketoacidosis the greater the vacuolization.


Basal vacuolization can also occur in hypothermia.


An iron stain can help to exclude hemosiderin deposition.


Measurement of beta-hydroxubutyrate in the vitreous fluid can support the diagnosis of ketoacidosis.

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