A 55-year-old man found dead at home shows moderate decomposition. Vitreous urea is 38 mmol/L and creatinine is 950 micromol/L, both grossly elevated and proportionate. Blood could not be analysed. What is the MOST appropriate conclusion?

• A Postmortem diffusion of nitrogenous waste from bowel flora caused spurious elevation
• B The findings indicate acute tubular necrosis developing during the agonal period only
• C Decomposition raised urea selectively while creatinine remained artefactually low
• D The deceased likely suffered from chronic renal failure before death ✓

Explanation

Because vitreous urea and creatinine are stable after death and unaffected by decomposition, proportionate marked elevation of both reliably indicates ante-mortem uraemia, most often chronic renal failure. Putrefaction does not selectively generate urea in vitreous, and creatinine is not degraded preferentially. Acute agonal renal injury cannot produce such extreme, concordant levels, and the stability of these analytes is precisely why vitreous is preferred in decomposed bodies.

Reference: Parikh's Textbook of Medical Jurisprudence, Forensic Medicine and Toxicology, 7th ed.

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