National Renal Pathology E.Q.A. Scheme
Circulation R
This document gives information on individual cases in
circulation R of this scheme. It contains no personal details
of participants.
Cases included:
R 85
R 86
R 87
R 88
R 89
R 90
End
A click on the 
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: R
Case number: 85
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Number of responses:64 . Date of analysis: 17 APR 97
Clinical:
9 y.o. boy. Clinically acute / rapidly progressive glomerulonephritis. Case
from Israel (this fact may be irrelevant)
Specimen:
H&E, If for C3 transparency, E.M. *2.
Diagnostic categories: Score:
1 Mesangiocapillary glomerulonephritis 1.73
2 Diffuse proliferative glomerulonephritis 3.36
3 Interstitial nephritis 0.34
4 Focal glomerulonephritis 0.16
5 SLE 0.14
6 Post-streptococcal Gn (Merge with 2??) 1.72
7 Mesangial proliferative Gn 2.11
8 Mesangial C3 disease 0.16
9 Microangiopathy 0.13
10 Minimal change nephropathy 0.16
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 2 with 3.36
Secondary diagnoses and comments (if any):
ANCA?*1. Lupus serology?*1. Drug Hx?*3. ASOT etc.*6. Unsuitable for EQA*
3. Infective endocarditis?*1. PAS*3, Silver*4. Other IF results*5. ?SLE*1.
Hereditary renal disease?*1.
(Some participants did not receive C3 transparency)
Original report and further information (if any):
Circulation: R
Case number: 86
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Number of responses:61 . Date of analysis: 17 APR 97
Clinical:
53y.o. woman with Sjogren's. Raynaud's phenomenon, polyarthritis,
peripheral neuropathy and lymphopenia for several years. Suddenly developed
renal failure. Creatinine 160, urea 16. IF: diffuse large 'globular'
positivity in capillary walls & lumina, IgG&M, each ++++. Weaker C3. EM:
Specimen:
H&E, PAS. FOR EDUCATION NOT AUDIT
Diagnostic categories: Score:
1 Cryoglobulinaemia 7.84
2 Macroglobulinaemia 0.72
3 SLE 0.46
4 Light chain nephropathy 0.16
5 Thrombotic microangiopathy 0.33
6 Sjogren's nephropathy 0.08
7 Mesangiocapillary glomerulonephritis 0.16
10 No response / no specific response 0.24
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 7.84
Secondary diagnoses and comments (if any):
Hep. C status?*1. E.M.*1. Anti-phospholipid antibody?*1. ?SLE*1. Congo
red*1. Kappa & lambda*2. Serology for syphilis, malaria*1. Bone marrow Bx
*1.
Original report and further information (if any):
Circulation: R
Case number: 87
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Number of responses:64 . Date of analysis: 17 APR 97
Clinical:
43y.o. male. Psoriasis with arthropathy. Creatinine 750; decreased to 365
in 10 days. Immunbofluorescence negative. E.M. not done.
Specimen:
H&E, Jones silver
Diagnostic categories: Score:
1 Ischaemic changes / ATN 1.19
2 Interstitial nephritis 4.75
3 Myeloma kidney 0.33
4 Acute pyelonephritis 0.97
5 Mesangiocapillary glomerulonephritis 0.31
6 Nephropathy due to crystal deposition 0.31
7 Interstitial nephritis and acute pyelo. both mentioned 1.83
8 Microangiopathy 0.16
9 Analgesic nephropathy 0.16
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 2 with 4.75
Secondary diagnoses and comments (if any):
Chronic interstitial nephritis too*2. Crystals?cause?gout*8. Drug
history?*19. HIV?*1. Repeat IF*1. E.M.*1. MSB*1. Congo red*3. Exclude
myeloma*4.
Original report and further information (if any):
Acute interstitial nephritis, a little irreversible tubulointerstitial
damage. Patient recovered.
Circulation: R
Case number: 88
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Number of responses:64 . Date of analysis: 17 APR 97
Clinical:
48 year old woman with known scleroderma who was admitted in acute renal
failure and noted to have malignant hypertension
Specimen:
H&E
Diagnostic categories: Score:
1 Scleroderma & malignant hypertension 9.69
2 Acute thrombotic angiopathy 0.31
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 9.69
Secondary diagnoses and comments (if any):
Haematological evidence of microangiopathy?*1. Silver*2. Immuno*2. PAS*
1. Congo red *1. E.M.*1.
Original report and further information (if any):
Cortical infarction attributable to systemic sclerosis and malignant phase
hypertension (i.e 'renal crisis' of scleroderma). It is difficult to sort
out the relative contribution of the two components.
Patient did not recover renal function and is now on dialysis.
Circulation: R
Case number: 89
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Number of responses:64 . Date of analysis: 17 APR 97
Clinical:
Male aged 9. Nephrotic range proteinuria and haematuria for at least 8
months. reduced IgG; complement levels not available. Also strong positive
staining for IgG and IgA in the glomeruli; C1q and C4 present at glomerular
peripheries
Macro:
H&E, silver*2, IF prints *2 (IgM&C3; labelled on reverse), E.M. prints*3.
PHOTOGRAPHS NOT SEPARATELY LABELLED; PLEASE DO NOT SEPARATE THEM
Diagnostic categories: Score:
1 Mesangiocapillary glomerulonephritis 6.20
2 Focal segmental proliferative glomerulonephritis 0.77
3 IgA nephropathy 0.47
4 Diffuse proliferative glomerulonephritis 1.20
5 Lupus nephritis 1.20
6 Schönlein - Henoch 0.01
7 Focal segmental glomerulosclerosis 0.16
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 6.20
Secondary diagnoses and comments (if any):
MCGN Type I*23. Exclude lupus*11. Exclude infective endocarditis*1. GBM
splitting - ?secondary*1. Henoch-Schönlein?*1.
EM not included *1.
Original report and further information (if any):
Membranoproliferative glomerulonephritis, type I. Further information: C3
and C4 in normal range. Hypercholesterolaemia, treated with Simvastatin.
No steroid treatment. Urine P/C ratio has fallen from 1567 to 423mg/mmol
(Normal <20; nephrotic range >200).
Circulation: R
Case number: 90
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Number of responses:64 . Date of analysis: 17 APR 97
Clinical:
27y.o healty male, +++ proteinuria on routine medical - 4.03g/24h. O/E:
fit, healthy man. BP150/85. Normal renal function. IF: diffuse granular
capillary loop deposits of IgA, IgM, C3 & C1q.
Specimen:
PAS, electron micrograph *1
Diagnostic categories: Score:
1 Mesangiocapillary glomerulonephritis 9.42
2 Membranous glomerulonephritis 0.31
3 SLE 0.16
4 Focal segmental glomerulosclerosis 0.08
5 Light chain nephropathy 0.03
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 9.42
Secondary diagnoses and comments (if any):
MCGn type II*56. MCGn type I*1. Associated clinical features?*1. Exclude
lupus*1. Silver*1. Trichrome*1.
Original report and further information (if any):
Dense deposit disease. Ultrastructural imunogold showed accumulation of C9
in the deposits.
Links to cases in this document:
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R 85
R 86
R 87
R 88
R 89
R 90
Home Page
CWIS
Pathology EQA
Last updated: 17 APR 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.
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