"Shock kidney-like Appearance": Objective evaluation of renal color changes in hemorrhagic shock deaths

Severe bleeding due to various traumatic injuries can cause hemorrhagic shock, which is difficult to diagnose using forensic medicine. Therefore, we defined the difference in color between the renal cortex and medulla observed in hemorrhagic shock deaths as "shock kidney-like appearance (SKLA)" and digitally analyzed the color difference with a digital camera and color analysis software. The aim of this study was to develop and evaluate a method for objectively determining SKLA and improve the accuracy of forensic diagnosis. We examined the kidneys of 122 cases (83 males and 39 females; average age, 64.8 years) autopsied at our facility. Using Image J, we analyzed the color of the cortex and medulla from photographs of bisected kidneys. We defined the color difference between the cortex and medulla in the L*a*b* color space as cortical-medullary color difference and performed a comparative analysis between the hemorrhage and control groups. Significant differences were observed in Delta L* and Delta a* values between the two groups (p < 0.05 and p < 0.001, respectively). Analysis of Delta a* values showed that the cortex was less reddish than the medulla in the hemorrhage group. The cutoff value for determining SKLA was set at Delta a* = -1.33 (sensitivity, 0.79; specificity, 0.81; AUC, 0.859). Traditional evaluations of color rely on subjective assessments, which raise issues of reliability and reproducibility. This study successfully overcame the limitations of subjective evaluation by objectively assessing cortical-medullary color difference in the kidneys. Our results represent an important step towards improving the objectivity of color evaluations.