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Originally described in diabetic ketoacidosis, renal vacuoles can be found in other ketogenic states such as alcoholic ketoacidosis (AKA), starvation, and hypothermia, underpinned by deranged fatty acid metabolism. A retrospective analysis of 133 deaths associated with alcohol use disorder (AUD) examined at autopsy between 2017 and 2020 was undertaken. This study aimed to determine the prevalence of subnuclear vacuoles in deaths of those with AUD and their specificity for deaths from AKA, and to elucidate what demographic, biochemical, and pathologic findings are associated with subnuclear vacuoles. In each case, vitreous humor biochemistry including electrolytes, glucose, and beta\u2010hydroxybutyrate (BHB) was analyzed alongside postmortem hemoglobin A1c and renal and liver histology. Renal histology was graded for the presence of vacuoles as absent (0), scanty (1), or easily identifiable (2). Liver histology was graded for steatosis and for fibrosis if Masson trichrome staining was available. Vacuoles were commonly seen in the deaths of those with AUD. They were seen in deaths due to AKA but were not specific to that cause of death. With vacuoles present, lower vitreous sodium (139 vs. 142\u2009mmol\/L; <jats:italic>p<\/jats:italic>\u2009=\u20090.005), higher vitreous BHB (1.50 vs. 1.39\u2009mmol\/L; <jats:italic>p<\/jats:italic>\u2009=\u20090.04), severe hepatic steatosis, and severe hepatic fibrosis were seen, compared with those without renal vacuoles.<\/jats:p>","DOI":"10.1111\/1556-4029.15321","type":"journal-article","created":{"date-parts":[[2023,7,6]],"date-time":"2023-07-06T10:02:04Z","timestamp":1688637724000},"page":"1759-1767","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Subnuclear renal tubular vacuoles in alcohol use disorder"],"prefix":"10.1111","volume":"68","author":[{"given":"Finn M.","family":"Auld","sequence":"first","affiliation":[{"name":"Department of Pathology and Laboratory Medicine University of Ottawa  Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaqueline L.","family":"Parai","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine University of Ottawa  Ottawa Ontario Canada"},{"name":"Division of Anatomical Pathology, The Ottawa Hospital, Eastern Ontario Regional Forensic Pathology Unit Ontario Forensic Pathology Service  Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher M.","family":"Milroy","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine University of Ottawa  Ottawa Ontario Canada"},{"name":"Division of Anatomical Pathology, The Ottawa Hospital, Eastern Ontario Regional Forensic Pathology Unit Ontario Forensic Pathology Service  Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,7,6]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"National Institute on Alcohol Abuse and Alcoholism.Alcohol's effects on health. 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