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Urea nitrogen, creatinine, and uric acid levels in postmortem serum, vitreous humor, and pericardial fluid

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Abstract

Urea nitrogen, creatinine, and uric acid are relatively stable in postmortem serum and may, therefore, be used for diagnostic purposes when chronic kidney disease and end-stage renal failure are investigated as causes of death. Nevertheless, uncertainties remain in defining the best alternative to postmortem serum for the identification and assessment of significantly decreased kidney function. In this study, we investigated urea nitrogen, creatinine, and uric acid levels in postmortem serum, pericardial fluid, and vitreous humor in a series of medico-legal cases (500 autopsies) with various causes of death. No postmortem interval-related differences were observed in any of the investigated fluids for any analyzed parameter, confirming the biochemical stability of all compounds after death. Data analysis failed to reveal statistically significant differences between postmortem serum and pericardial fluid urea nitrogen, creatinine, and uric acid concentrations. Conversely, statistically significant differences were observed in all analyzed biomarkers between postmortem serum and vitreous humor levels, with lower concentrations of all markers measured in vitreous. The results of this study suggest that, in order to estimate as accurately as possible blood analyte concentrations at the time of death, pericardial fluid should be preferred to vitreous humor.

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References

  1. Levey AS, Coresh J (2012) Chronic kidney disease. Lancet 379:165–180

    Article  PubMed  Google Scholar 

  2. Wen CP, Cheng TY, Tsai MK, Chang YC, Chan HT, Tsai SP, Chiang PH, Hsu CC, Sung PK, Hsu YH, Wen SF (2008) All-cause mortality attributable to chronic kidney disease: a prospective cohort study based on 462 293 adults in Taiwan. Lancet 371:2173–2182

    Article  PubMed  Google Scholar 

  3. Ortega LM, Arora S (2012) Metabolic acidosis and progression of chronic kidney disease: incidence, pathogenesis, and therapeutic options. Nefrologia 32:724–730

    PubMed  Google Scholar 

  4. Eknoyan G (2007) Chronic kidney disease definition and classification: the quest for refinement. Kidney Int 72:1183–1185

    Article  CAS  PubMed  Google Scholar 

  5. Winearls CG, Haynes R, Glassock R (2010) CKD staging—evolution not revolution. Nefrologia 30:493–500

    CAS  PubMed  Google Scholar 

  6. Turner JM, Bauer C, Abramowitz MK, Melamed ML, Hostetter TH (2012) Treatment of chronic kidney disease. Kidney Int 81:351–362

    Article  CAS  PubMed  Google Scholar 

  7. White CA, Akbari A (2011) The estimation, measurement, and relevance of the glomerular filtration rate in stage 5 chronic kidney disease. Semin Dial 24:540–549

    Article  PubMed  Google Scholar 

  8. Lamb EJ, Stevens PE (2014) Estimating and measuring glomerular filtration rate: methods of measurement and markers for estimation. Curr Opin Nephrol Hypertens 23:258–266

    Article  CAS  PubMed  Google Scholar 

  9. Zhu BL, Ishida K, Quan L, Taniguchi M, Oritani S, Li DR, Fujita MQ, Maeda H (2002) Postmortem serum uric acid and creatinine levels in relation to the causes of death. Forensic Sci Int 125:59–66

    Article  CAS  PubMed  Google Scholar 

  10. Zhu BL, Ishikawa T, Michiue T, Tanaka S, Zhao D, Li DR, Quan L, Oritani S, Maeda H (2007) Differences in postmortem urea nitrogen, creatinine and uric acid levels between blood and pericardial fluid in acute death. Legal Med (Tokyo) 9:115–122

    Article  CAS  Google Scholar 

  11. Uemura K, Shintani-Ishida K, Saka K, Nakajima M, Ikegaya H, Kikuchi Y, Yoshida K (2008) Biochemical blood markers and sampling sites in forensic autopsy. J Forensic Legal Med 15:312–317

    Article  Google Scholar 

  12. Coe JI (1993) Postmortem chemistry update. Emphasis on forensic application. Am J Forensic Med Pathol 14:91–117

    Article  CAS  PubMed  Google Scholar 

  13. Maeda H, Zhu BL, Bessho Y, Ishikawa T, Quan L, Michiue T, Zhao D, Li DR, Komatsu A (2008) Postmortem serum nitrogen compounds and C-reactive protein levels with special regard to investigation of fatal hyperthermia. Forensic Sci Med Pathol 4:175–180

    Article  CAS  PubMed  Google Scholar 

  14. Zhu BL, Ishikawa T, Michiue T, Li DR, Zhao D, Quan L, Maeda H (2005) Evaluation of postmortem urea nitrogen, creatinine and uric acid levels in pericardial fluid in forensic autopsy. Legal Med (Tokyo) 7:287–292

    Article  CAS  Google Scholar 

  15. Kawamoto O, Michiue T, Ishikawa T, Maeda H (2013) Comprehensive evaluation of pericardial biochemical markers in death investigation. Forensic Sci Int 224:73–79

    Article  CAS  PubMed  Google Scholar 

  16. Balasooriya BA, St Hill CA, Williams AR (1984) The biochemistry of vitreous humour. A comparative study of the potassium, sodium and urate concentrations in the eyes at identical time intervals after death. Forensic Sci Int 26:85–91

    Article  CAS  PubMed  Google Scholar 

  17. Arroyo A, Valero J, Marrón T, Vidal C, Hontecillas B, Bernal J (1998) Pericardial fluid postmortem: comparative study of natural and violent deaths. Am J Forensic Med Pathol 19:266–268

    Article  CAS  PubMed  Google Scholar 

  18. Madea B, Kreuser C, Banaschak S (2001) Postmortem biochemical examination of synovial fluid - a preliminary study. Forensic Sci Int 118:29–35

    Article  CAS  PubMed  Google Scholar 

  19. Gagajewski A, Murakami MM, Kloss J, Edstrom M, Hillyer M, Peterson GF, Amatuzio J, Apple FS (2004) Measurement of chemical analytes in vitreous humor: stability and precision studies. J Forensic Sci 49:371–374

    Article  CAS  PubMed  Google Scholar 

  20. Arroyo A, Rosel P, Marrón T (2005) Cerebrospinal fluid: postmortem biochemical study. J Clin Forensic Med 12:153–156

    Article  CAS  PubMed  Google Scholar 

  21. Thierauf A, Musshoff F, Madea B (2009) Postmortem biochemical investigations of vitreous humor. Forensic Sci Int 192:78–82

    Article  CAS  PubMed  Google Scholar 

  22. Naumann HN (1949) Diabetes and uremia diagnosed at autopsy by testing cerebrospinal fluid and urine. Arch Pathol (Chic) 47:70–77

    CAS  Google Scholar 

  23. Naumann HN (1959) Postmortem chemistry of the vitreous body in man. Arch Ophthalmol 62:356–363

    Article  CAS  PubMed  Google Scholar 

  24. Coe JI (1972) Use of chemical determinations on vitreous humor in forensic pathology. J Forensic Sci 17:541–546

    CAS  PubMed  Google Scholar 

  25. Coe JI (1973) Some further thoughts and observations on postmortem chemistries. Forensic Sci Gazette 5:2–6

    Google Scholar 

  26. Madea B, Lachenmeier DW (2005) Postmortem diagnosis of hypertonic dehydration. Forensic Sci Int 155:1–6

    Article  CAS  PubMed  Google Scholar 

  27. Leahy MS, Farber ER (1967) Postmortem chemistry of human vitreous humor. J Forensic Sci 12:214–222

    CAS  PubMed  Google Scholar 

  28. Palmiere C, Mangin P (2012) Postmortem chemistry update part I. Int J Legal Med 126:187–198

    Article  PubMed  Google Scholar 

  29. Mitchell R, Charlwood C, Thomas SD, Bellis M, Langlois NE (2013) An audit of the contribution to post-mortem examination diagnosis of individual analyte results obtained from biochemical analysis of the vitreous. Forensic Sci Med Pathol 9:515–520

    Article  CAS  PubMed  Google Scholar 

  30. Tumram NK, Bardale RV, Dongre AP (2011) Postmortem analysis of synovial fluid and vitreous humour for determination of death interval: a comparative study. Forensic Sci Int 204:186–190

    Article  CAS  PubMed  Google Scholar 

  31. Li DR, Quan L, Zhu BL, Ishikawa T, Michiue T, Zhao D, Yoshida C, Chen JH, Wang Q, Komatsu A, Azuma Y, Maeda H (2009) Evaluation of postmortem calcium and magnesium levels in the pericardial fluid with regard to the cause of death in medicolegal autopsy. Forensic Sci Int 11(Suppl 1):S276–S278

    Google Scholar 

  32. Zhu BL, Ishikawa T, Michiue T, Li DR, Zhao D, Oritani S, Kamikodai Y, Tsuda K, Okazaki S, Maeda H (2006) Postmortem cardiac troponin T levels in the blood and pericardial fluid. Part 1. Analysis with special regard to traumatic causes of death. Legal Med (Tokyo) 8:86–93

    Article  CAS  Google Scholar 

  33. Zhu BL, Ishikawa T, Michiue T, Li DR, Zhao D, Kamikodai Y, Tsuda K, Okazaki S, Maeda H (2006) Postmortem cardiac troponin T levels in the blood and pericardial fluid. Part 2: analysis for application in the diagnosis of sudden cardiac death with regard to pathology. Legal Med (Tokyo) 8:94–101

    Article  CAS  Google Scholar 

  34. Zhu BL, Ishikawa T, Michiue T, Li DR, Zhao D, Bessho Y, Kamikodai Y, Tsuda K, Okazaki S, Maeda H (2007) Postmortem cardiac troponin I and creatine kinase MB levels in the blood and pericardial fluid as markers of myocardial damage in medicolegal autopsy. Legal Med (Tokyo) 9:241–250

    Article  CAS  Google Scholar 

  35. Wang Q, Michiue T, Ishikawa T, Zhu BL, Maeda H (2001) Combined analyses of creatine kinase MB, cardiac troponin I and myoglobin in pericardial and cerebrospinal fluids to investigate myocardial and skeletal muscle injury in medicolegal autopsy cases. Legal Med (Tokyo) 13:226–232

    Article  Google Scholar 

  36. Quan L, Ishikawa T, Hara J, Michiue T, Chen JH, Wang Q, Zhu BL, Maeda H (2011) Postmortem serotonin levels in cerebrospinal and pericardial fluids with regard to the cause of death in medicolegal autopsy. Legal Med (Tokyo) 13:75–78

    Article  CAS  Google Scholar 

  37. Ishikawa T, Quan L, Michiue T, Kawamoto O, Wang Q, Chen JH, Zhu BL, Maeda H (2013) Postmortem catecholamine levels in pericardial and cerebrospinal fluids with regard to the cause of death in medicolegal autopsy. Forensic Sci Int 228:52–60

    Article  CAS  PubMed  Google Scholar 

  38. Luna A, Villanueva E, Castellano M, Jimenez J (1982) The determination of CK, LDH and its isoenzymes in pericardial fluid and its application to the post-mortem diagnosis of myocardial infarction. Forensic Sci Int 19:85–91

    Article  CAS  PubMed  Google Scholar 

  39. Luna A, Carmona A, Villanueva E (1983) The postmortem determination of CK isozymes in the pericardial fluid in various causes of death. Forensic Sci Int 22:23–30

    Article  CAS  PubMed  Google Scholar 

  40. Balasooriya BA, St Hill CA, Williams AR (1984) The biochemical changes in pericardial fluid after death. An investigation of the relationship between the time since death and the rise or fall in electrolyte and enzyme concentrations and their possible usefulness in determining the time of death. Forensic Sci Int 26:93–102

    Article  CAS  PubMed  Google Scholar 

  41. Valenzuela A, Hougen HP, Villanueva E (1994) Lipoproteins and apolipoproteins in pericardial fluid: new postmortem markers for coronary atherosclerosis. Forensic Sci Int 66:81–88

    Article  CAS  PubMed  Google Scholar 

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This study was not financially supported.

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The authors disclose any financial and personal relationship with other people or organizations that could potentially or inappropriately influence their work and conclusions.

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  1. University Centre of Legal Medicine, Rue du Bugnon 21, 1011, Lausanne, Switzerland

    Cristian Palmiere & Patrice Mangin

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  1. Cristian Palmiere
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  2. Patrice Mangin
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Correspondence to Cristian Palmiere.

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Palmiere, C., Mangin, P. Urea nitrogen, creatinine, and uric acid levels in postmortem serum, vitreous humor, and pericardial fluid. Int J Legal Med 129, 301–305 (2015). https://doi.org/10.1007/s00414-014-1076-z

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  • DOI: https://doi.org/10.1007/s00414-014-1076-z

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