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National Renal Pathology E.Q.A. Scheme

Circulation N

This document gives information on individual cases in circulation N of this scheme. It contains no personal details of participants.

Cases included:

N 67
N 68
N 69
N 70
N 71
End

A click on the { Image} icon should provide an image from the material circulated. Some but not all cases will have two images.

WARNING The image files associated with this document are selected by the Organiser in an attempt to illustrate the relevant features of the material which was circulated in the EQA scheme. They are intended as a 'aide memoire' for participants who may no longer have the slides for review.

They are NOT intended as 'good examples' or as teaching material. In some instances the images (especially the second image) may be chosen to illustrate a feature which led some participants to a wrong diagnosis.

Case Response Analysis

Circulation: N

Case number: 67 .... {Image} .... {Image}


Number of responses:61 . Date of analysis: 10 DEC 95

Clinical:

51 y.o. woman, nephrotic syndrome ? cause. Proteinuria 6.6g/24h. No other medical history. IF described as 'non-specific staining of IgM and IgA in glomeruli; IgG and C3 negative'. E.M. not available.

Specimen:

H&E, Congo Red 
Diagnostic categories:                         Score:
 1  Amyloidosis                                             10.00
 9  ...                                                     0.00
 10 No response                                             0.00

Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 10.00

Secondary diagnoses and comments (if any):

Stain for amyloid type*14. Immunoelectrophoresis*8.Clinical history?*2. Would not polarize; para-amyloid?*1. Myeloma?*3. Bone marrow *1. Rheumatoid?*1.

Original report and further information (if any):

Renal amyloidosis.

Circulation: N

Case number: 68 .... {Image} .... {Image}


Number of responses:61 . Date of analysis: 10 DEC 95

Clinical:

20 y.o. male, nephrotic syndrome, normotensive, immune profile negative. No clinical features of Fabry's disease. Report issued before IF and E.M. became available, so results of these investigations are not provided. They did not conflict with the report issued.

Specimen:

H&E, PAS, silver 
Diagnostic categories:                         Score:
 1  Focal segmental glomerulosclerosis                      5.77
 2  Minimal change nephrotic syndrome                       0.18
 3  Fabry's disease                                         1.70
 4  Wegener's / PAN                                         0.08
 5  LCAT deficiency                                         0.13
 6  'Other causes of glomerular foam cells'                 0.05
 7  Mesangiocapillary/membranoproliferative glomerulonephrit0.74
 8  Focal segmental proliferative Gn.                       0.52
 9  Membranous Gn.                                          0.49
 10 No/vague/unclassifiable response                        0.33

Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 5.77

Secondary diagnoses and comments (if any):

Need IF*6. Need E.M.*7. Clinical history*2. Inappropriate for EQA*4. Fabry's diagnosed because of mention in history (?!)*1. Why was Fabry's suspected?*1. Enzyme assay for Fabry's?*1.

Original report and further information (if any):

Focal segmental glomerulosclerosis and hyalinosis. Some improvement on pred. & CyA. Subsequent biopsy in another hospital also showed FSGS.

Circulation: N

Case number: 69 .... {Image} .... {Image}


Number of responses:61 . Date of analysis: 10 DEC 95

Clinical:

Female age 3. Nephrotic syndrome. Steroid dependant. Immuno: strong IgM, weak C1q in mesangial regions of all glomeruli.

Specimen:

H&E, PAS, E.M. x2 
Diagnostic categories:                         Score:
 1  Minimal change nephropathy                              6.34
 2  Congenital nephrotic syndrome                           0.31
 3  IgM nephropathy                                         1.84
 4  FSGS                                                    0.23
 5  Mesangial proliferative glomerulonephritis              0.74
 6  Mesangiocapillary glomerulonephritis                    0.16
 7  Cystic disease of tubules                               0.05
 8  Alport's syndrome                                       0.25
 9  Thin membrane nephropathy                               0.08
 10 Some participants seem to use 1 and 3 as synonyms. Merge0.00

Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 6.34

Secondary diagnoses and comments (if any):

Age 3 months or years?*1. Minimal change diagnosed but worries about IgM* 6. Nephrocalcinosis*1. Thin membrane nephropathy?*2 (no scale!).

Original report and further information (if any):

Minimal change nephrotic syndrome, though focal segmental sclerosis cannot be excluded. At last follow up: well, on cyclophosphamide, trace of proteinuria.

Circulation: N

Case number: 70 .... {Image} .... {Image}


Number of responses:61 . Date of analysis: 10 DEC 95

Clinical:

54 y.o. male, diabetes mellitus for 20 years, retinopathy, 2/3g proteinuria per 24 hours. Creatinine over 900. Clinical diagnosis was diabetic nephropathy.

Specimen:

H&E 
Diagnostic categories:                         Score:
 1  Diabetic nephropathy                                    9.80
 2  Amyloidosis                                             0.02
 3  Light chain nephropathy                                 0.16
 4  Mesangial proliferative glomerulonephritis              0.02

Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 9.80

Secondary diagnoses and comments (if any):

Immuno. *5. E.M.*3. Masson trichrome *1. PAS*2. Amyloid stain*7. Silver stain*2. Exclude other causes of nodular glomerulosclerosis*5. Also hypertensive / ischaemic changes*4. Malignant HT?*1.Nephrocalcinosis*1. Immunoelectrophoresis*2.

Original report and further information (if any):

Advanced iabetic nephropathy. Congo red negative.

Circulation: N

Case number: 71 .... {Image} .... {Image}


Number of responses:61 . Date of analysis: 10 DEC 95

Clinical:

58y.o. female, hoarse voice, one episode haemoptysis, deteriorating renal function, blood & protein in urine. Clinically Wegener's. IgA & C3 similar to IgG & IgM but weaker. No gloms. in e.m. sample.

Specimen:

H&E, Jones' silver, 2 projn. slides of IF (IgG&M) 
Diagnostic categories:                         Score:
 1  Cryoglobulinaemia                                       1.79
 2  Proliferative Gn +/- vasculitis/Wegener's               6.15
 3  SLE                                                     1.07
 4  Mesaniocapillary glomerulonephritis                     0.08
 5  IgM dysproteinaemia  (Is this = cryoglob.?-PF)          0.16
 6  Goodpasture's                                           0.08
 7  Haemolytic-uraemic / microangiopathy                    0.33
 8  Endocapillary prolif. (post-strep) Gn.                  0.33
 9  Drug-induced Gn.                                        0.02

Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 2 with 6.15

Secondary diagnoses and comments (if any):

Cryoglobulin in plasma?*3. Intravascular oagulation?*1. ANCA*17. E.M.*4. ANF/lupus?*11. PAS*1. Hepatitis C status?*1. EM from paraffin block*2. Clinical discussion*1. ASO titre*2.

Original report and further information (if any):

Mesangiocapillary glomerulonephritis associated with a cryoglobulinaemia and vasculitis. The odd cast is suggestive of myeloma kidney in addition. Cryoglobulins subsequently found in the blood.

Links to cases in this document:
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N 67
N 68
N 69
N 70
N 71

[Leicester University] [] Pathology EQA
Last Updated: December 1995
Peter Furness BM, BCh, PhD, MRCPath, Department of Pathology, University of Leicester.