Obstructive uropathy and unexpected death

A 66-year-old man was found dead at his home address. He had a history of poor nutrition with recent episodes of vomiting. At autopsy the decedent was cachexic with a body mass index (BMI) of 16.1. The major findings were of marked prostatomegaly (165 g) with obstruction to urine outflow resulting in dilatation and trabeculation of the bladder and bilateral hydroureteronephrosis. The bladder contained 1.5 l of yellow urine and the kidneys weighed only 109 g on the left and 125 g on the right (N = 140-160 g). Histological examination of the prostate revealed benign nodular hyperplasia. Biochemical analysis of vitreous humor demonstrated a creatinine of 1579 μmol/L (normal 45-90) and a urea of 133.4 mmol/L (normal 2.5-7.1). Despite genitourinary causes of sudden and/or unexpected death being rare in routine forensic practice, this case demonstrates significant underlying obstructive renal disease that resulted in sudden death and that had remained undiagnosed until the time of autopsy.