296 • J. Blackman, M.J. Allison, A.C. Aufderheide, N. Oldroyd, and R.T. Steinbock 



The nature of the postulated primary renal disease cannot 

 be established histologically; this only reveals diftusely de- 

 stroyed, fibrotic and calcified parenchyma of end-stage 

 chronic renal disease. Chronic pyelonephritis would be sus- 

 pected on the basis of frequency, though the inflammatory 

 cells would not be preserved in a spontaneously mummified 

 body. The noted size asymmetry is common in this condition. 

 Glomerulonephritis does not normally produce calculi. No 

 congenital renal deformities are recognizable. Furthermore, 

 the formation of calculi in an infected kidney is a well-known 

 phenomenon. Somewhat disturbing is the fact that struvite 

 accounts for only 10% of the stone's weight, but in chronic 

 pyelonephritis the organisms may be minimal or absent in the 

 late stage of the disease, and many crystals may have been 

 added to the calculus during the terminal stage of secondary 

 hyperparathyroidism. 



The bilateral, moderately dilated ureters are most easily 

 explained by assuming the passage of previous calculi with 

 transient, obstructive episodes. 



The nature of the bilateral neck masses could not be deter- 

 mined beyond equivocation. While their histologic pattern 

 suggests a glandular nature, immunologic procedures could 

 not differentiate between thyroid or parathyroid tissue. Nor- 

 mal thyroid tissue (and certainly also the small, normal para- 

 thyroid glands) cannot usually be identified in spontaneously 

 mummified bodies (Gerszten et al. 1976). Even if positively 

 identified as parathyroid, their multiple, enlarged status 

 would not be useful in separating primary from secondary 

 hyperparathyroidism since 15% of the former and 100% of 

 the latter reveal enlargement of more than one gland. 



The mild pulmonary fibrosis is most likely secondary to 

 inhalation of the soil dust visualized in the histologic sections 

 with polarized light and identified by EDXA (El-Najjaretal. 

 1985:274). It is conceivable, however, that the major episode 

 of left pneumonia (evidenced by massive left pleural adhe- 

 sions) suffered at some previous time may have caused bac- 

 teremia and been the source of the original pyelonephritis 

 episode. 



In summary, this 18-year-oId Cabuza male most likely 

 suffered renal destruction from chronic pyelonephritis with 

 secondary renal urolithiasis, chronic renal failure, uremic 



pericarditis, and secondary hyperparathyroidism leading to 

 diffuse, bilateral nephrocalcinosis. Alternative diagnoses ap- 

 pear to be less probable. 



Literature cited 



El-Najjar. M.. A.C. Aufderheide. and D.J. Ortner. 1985. Preserved 

 Human Remains from the Southern Region of the North Ameri- 

 can Continent: Report of Autopsy Findings. Hitman Pathology, 

 16:273-276. 



Gerszten, E., M.J. Allison, A. Pezzia, and D. Klurfeld. 1976. 

 Thyroid Disease in a Peruvian Mummy. MCV Quarterly, 12:52- 

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Heptinstall, R.H. 1983. Pathology of the Kidney. 1599-1634. 

 Boston: Little. Brown and Company. 



Johnson, F.B.. and K. Pani. 1962. Histochemical Identification of 

 Calcium Oxalate. Archives of Pathology, 74:347-351. 



Kissane, J.M., and M.G. Smith. 1969. Pathology of Infancy and 

 Childhood. St. Louis: C.V. Mosby. 



Longcope. W.T , and D.G. Freiman. 1952. A Study of Sarcoidosis. 

 Medicine, 31:1-132. 



Potts, J.T., Jr. 1983. Disorders of Parathyroid Glands. In R.G. 

 Peterson et al. , eds. . Harrison s Principles of Internal Medicine. 

 New York: McGraw-Hill. 



Streitz, J.M.. AC. Aufderheide, M. El-Najjar. and D.J. Ortner. 

 1981. A 1 ,500- Year-Old Bladder Stone. Journal of Urology, 

 126:452-453. 



Zimmerman. MR. 1976. A Paleopathologic Archeologic Inves- 

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Summary of audience discussion: The stone consisted of 50% 

 organic matter whose nature is speculative, but could have been a 

 sloughed renal papilla. The absence of osteitis fibrosa cystica 

 (parathormone-induced foci of bone lysis filled with fibrous tissue) 

 is probably the consequence of the shorter time period available in 

 the secondary form of hyperparathyroidism. Morphologic evidence 

 of hyperparathyroidism can, however, still be recognized in ancient 

 skeletal tissues by the "swiss cheese" pattern in trabeculae produced 

 by the tunneling effect of parathormone-stimulated osteoblastic 

 clusters. 



Zagreb Paleopathology Symp. 1988 



