The patient was a man aged 52 who died from subacute lymphatic leukaemia after an illness lasting 7 months. On his final admission there was rectal bleeding and renal failure. The platelets dropped to less than 10,000 and petechial haemorrhages appeared on the skin. He died after 5 days in hospital.
The specimen is of the kidney measuring 11 cms in length with a generally regular surface on which there are scattered small purpuric spots. The cut surface shows widening and pallor of the cortex with a loss of demarcation from the medulla. There is widespread acute haemorrhage beneath the mucosa of the calyces, the pelvis and the ureter. Histology shows scattered streaks of acute pyelonephritis in which tubules contain pus, but there is no interstitial leukaemic infiltrate. The pelvic haemorrhage is relatively acute, but there is some surrounding mononuclear reaction.