Comprehensive Histopathological Study of Postmortem Renal Tissues: A Retrospective Study in Baghdad (2020-2024)

Background: Autopsy represents a comprehensive method for direct macroscopic and microscopic assessment of organs following death. Despite progress in imaging and molecular studies, postmortem renal histopathological examination continues to be the most reliable method for precise identification of renal diseases. Objective: To determine the frequency of renal diseases in autopsy cases, identify pathological findings, and assess their association with demographic factors. Methods: A retrospective study was conducted over one year on 1,834 postmortem renal tissue samples obtained from autopsies performed between 2020 and 2024 at the Directorate of Forensic Medicine, Baghdad, Iraq. Renal lesions were classified as tumor, glomerular, tubular, interstitial, and vascular. Results: Autolysis was present in 102 cases. Out of the 1,732 autopsy cases, 73% were male, with an average age of 52.8±18.4 years. Hemorrhagic foci were the most prevalent gross finding (72.9%), with tubulointerstitial lesions being the most common histological pattern (64.1%). Pyelonephritis was the most common microscopic diagnosis (40.8%). Renal cell carcinoma was the most prevalent neoplasm (52.9%). Renal diagnoses were significantly associated with age and sex (p<0.001). Conclusions: Males were more likely to develop renal pathological abnormalities, which increased as they aged. The prevalence of hemorrhagic findings indicates a high incidence of acute and inflammatory kidney diseases, with pyelonephritis being the most common microscopic diagnosis. The discovery of malignant tumors demonstrated the value of postmortem renal histopathology investigation in identifying previously unknown illnesses.