{LOGO}

National Renal Pathology E.Q.A. Scheme

Circulation P


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

Cases included:

P 72
P 75
P 76
P 77
End



A click on the {
Image} icon should provide an image from the material circulated. Some of the images are composites - remember to scroll the image to see parts beyond the bottom of your screen.

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: P

Case number: 72 .... {Image} .... {Image}


Number of responses:59 . Date of analysis: 2 JUN 97

Clinical:

14 year old boy presenting with nephrotic syndrome and heavy proteinuria. First biopsy (not submitted) showed glomerular congestion but otherwise minimal change. Second biopsy 2 months later (present case) after ineffective treatment with steroid and cyclophosphamide. Nephrectomy done 2

Specimen:

H&E, PAS, PASM
Diagnostic categories:                         Score:
 1  Focal segmental glomerulosclerosis                      7.90
 2  Focal segmental proliferative glomerulonephritis        0.64
 3  Membranous glomerulonephritis                           0.17
 4  Minimal change nephropathy                              0.44
 5  Storage disorder (e.g. Fabry's)                         0.17
 6  Hereditary nephritis                                    0.12
 7  Mesangiocapillary glomerulonephritis                    0.34
 8  Tubulo-interstital nephritis                            0.14
 9  HUS                                                     0.08
Asterisks (if any) indicate dangerous diagnoses.     
Highest scoring diagnosis was 1 with 7.90

Secondary diagnoses and comments (if any):

Unsuitable for EQA*8. ATN too*1. 'Tip lesion' present*3. Renal vein thrombosis?*2. Pyelonephritis too*1. Lymphoma infiltration?*1. Drug effects?*1. Need immuno*16. Need E.M.*17. Reason for nephrectomy?*4. More clinical info*2.

Original report and further information (if any):

Focal segmental glomerulosclerosis. Subsequently recurrent pleural & pericardial effusions, reactive cytology, then high grade (Ki1 +ve) non- Hodkin's lymphoma. Nephrectomy showed segmental or global sclerosis of almost all glomeruli; 'malighant' focal segmental glomerulosclerosis ( sections available for review).


Circulation: P

Case number: 75 .... {Image} .... {Image}


Number of responses:59 . Date of analysis: 2 JUN 97

Clinical:

25y.o. female, 4 yr history of nephrotic syndrome not responding to prednisolone. Urea & creatinine normal. Normotensive. Immunoperoxidase: IgM and C3 in sclerosed glomeruli. E.M.: Diffuse loss of epithelial cell foot processes and localised thinning of basement membrane. No electron de

Specimen:

H&E, PAS, HxAg
Diagnostic categories:                         Score:
 1  Focal segmental glomerulosclerosis                      9.15
 2  Focal segmental glomerulonephritis                      0.17
 3  Mesangial proliferative glomerulonephritis              0.54
 4  Alport's syndrome                                       0.14
Asterisks (if any) indicate dangerous diagnoses.     
Highest scoring diagnosis was 1 with 9.15

Secondary diagnoses and comments (if any):

Congo red*1. Tip lesion present*3. Exclude Alport's *1. GBM thickness?*1.

Original report and further information (if any):

Focal segmental glomerulosclerosis with hyalinosis.


Circulation: P

Case number: 76 .... {Image} .... {Image}


Number of responses:54 . Date of analysis: 2 JUN 97

Clinical:

DIFFICULT CASE, NOT FOR PERSONAL ASSESSMENT. 27y.o. female. Appendicectomy 2 months earlier. Low platelets, low Hb, schistocytes on film at time but now normal haematology. Clinically ATN. No improvement in renal function, therefore biopsy. E.M. sample appeared autolytic - recent necrosis?. Immu
Diagnostic categories:                         Score:
 1  Vasculitis                                              0.87
 2  Microangiopathy                                         4.83
 3  Malignant hypertension                                  0.37
 4  Systemic sclerosis                                      1.57
 5  Allergic reaction                                       0.06
 6  Cortical necrosis                                       1.15
 7  Tubulo-interstitial nephritis                           0.57
 8  Anti-cardiolipin antibody syndrome                      0.02
 9  Lupus nephritis                                         0.00
 10 No diagnosis offered /other diagnoses (see below)       0.56
Asterisks (if any) indicate dangerous diagnoses.     
Highest scoring diagnosis was 2 with 4.83

Secondary diagnoses and comments (if any):

ANCA?*3. Pregnancy associated?*2. Drug-induced damage too?*1. Trichrome* 1. Hypertension?*1. Other diagnoses: 'All related to previous schistosomes' (Not my typo, for once!-PF)*1, , drug related?*1, Toxic - hepatorenal?*1, Intra-arterial organising thrombi?why*1,

Original report and further information (if any):


Circulation: P

Case number: 77 .... {Image}


Number of responses:55 . Date of analysis: 2 JUN 97

Clinical:

Woman, 68. Acute renal failure, haematuria, proteinuria. No rash, no joint problems, no lung problems. ANCA and anti-nuclear antibodies not detected. No other immunological investigations available at time of biopsy. Urgent provisional report requested on day of biopsy to determine emergency treatm

Specimen:

H&E only
Diagnostic categories:                         Score:
 1  Necrotising glomerulonephritis with crescents           9.64
 2  Malignant hypertesnsion                                 0.18
 3  Microangiopathy                                         0.18
Asterisks (if any) indicate dangerous diagnoses.     
Highest scoring diagnosis was 1 with 9.64

Secondary diagnoses and comments (if any):

Interstitial infiltrate lymphomatous??*1. Need E.M.*2. Need immuno.*8. Lupus?*2. Silver stain *2. Anti-GBM antibody?*16. Repeat ANCA*2. Exclude infective endocarditis*1. ATN too*1.

Original report and further information (if any):

Initial report severe acute vasculitic glomerulonephritis, almost certainly Goodpasture's disease - confirmed by linear IgG on IPx and anti-GBM in serum. Patient remains on dialysis 1 year later despite initial immunosuppression and plasma exchange.


Links to cases in this document:
Top
P 72
P 75
P 76
P 77


{} Home Page {} CWIS
Last updated: 2 JUN 97
Dr Peter Furness, PhD, MRCPath.
Department of Pathology,
Clinical Sciences Building,
Leicester Royal Infirmary,
P. O. Box 65,
Leicester, U.K.
Tel: (0116)2584582 Fax: (0116) 2584573
Email: pnf1@le. -->