Beethoven's Renal Disease Based on His Autopsy: A Case of Papillary Necrosis

doi:10.1016/S0272-6386(12)80038-2

American Journal of Kidney Diseases

Volume 21, Issue 6, June 1993, Pages 643-652

https://doi.org/10.1016/S0272-6386(12)80038-2 Get rights and content

Abstract

The autopsy report of Ludwig van Beethoven written by Dr Johann Wagner in 1827 reveals that he had renal calculi that had not been diagnosed during his lifetime, together with perirenal fibrosis. The most comprehensive interpretation of this autopsy finding is that the regular calcareous deposits in every one of his renal calices represented calcified necrotic papillae. Severe urinary obstruction or diabetes as possible causes of papillary necrosis were not present. Analgesic abuse because of headaches, back pain, and attacks of rheumatism or gout may be presumed on the basis of Beethoven's uncontrolled way of taking medication. Salicin, a commonly used analgesic substance of that time (dried and powdered willow bark), is able to cause papillary necrosis. Perirenal fibrosis may be due to chronic infection or drug intake. Beethoven's other well-known diseases are deafness caused by otosclerosis of the inner ear, relapsing attacks of diarrhea as the symptoms of irritable bowel syndrome, and liver cirrhosis following viral hepatitis and chronic alcohol consumption. Liver cirrhosis also may cause papillary necrosis. In Beethoven's case, renal papillary necrosis was most probably the consequence of analgesic abuse together with decompensated liver cirrhosis. The autopsy report of Beethoven is the first case of papillary necrosis recorded in the literature.

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Beethoven's Renal Disease Based on His Autopsy: A Case of Papillary Necrosis

Abstract

Am J Kidney Dis

Kidney Int

Gastroenterology

Am J Med

Am J Med

Am J Med

Am J Med

J Urol

Am J Med

Am J Med

Am J Med

J Urol

Kidney Int

J Urol

Am J Med

J Urol

J Biol Chem

Selbstbiographie and Antrittsrede

Urinary Lithiasis

Beethovens Gehörleiden

Wiener Med Wochenschr

Beethoven's deafness

JAMA

Otosklerose (Otospongiose)

Die Krankheiten Ludwig van Beethovens

Incidence of urinary calculi among patients in general hospitals, 1948-1952

JAMA

Nephrolithiasis as a complication of ulcerative colitis and regional enteritis

Ann Intern Med

Nephrolithiasis in inflammatory bowel disease

Am J Dig Dis

Urinary excretion of oxalate, calcium, magnesium, and uric acid in inflammatory bowel disease and relationship to urolithiasis

Gut

The extraintestinal complications of Crohn's disease and ulcerative colitis: A study of 700 patients

Medicine

Acquired hyperoxaluria, nephrolithiasis, and intestinal disease

N Engl J Med

Mechanism of hyperoxaluria in patients with ileal dysfunction

N Engl J Med

Oxalate and intestinal disease

J Clin Gastroenterol

Beethovens duBere Erscheinung. Seine Bildnisse

Beethoven's medical history

Ludwig van Beethoven

Beethoven: Case report of a titan's last crisis

Arch Intern Med

Editorial. Management of the irritable bowel

Lancet

Endocrine aspects of sarcoidosis

N Engl J Med

Renal manifestations and abnormal calcium metabolism in sarcoidosis

Q J Med