National Renal Pathology E.Q.A. Scheme
Circulation U
This document gives information on individual cases in
circulation U of this scheme. It contains no personal details
of participants.
Cases included:
U 248
U 249
U 250
U 251
U 252
U 253
End
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wrong diagnosis.
Case Response Analysis
Circulation: U
Case number: 248
....
Number of responses:86 . Date of analysis: 31 DEC 05
Clinical:
40 y.o. female. Haematuria 3+. Proteinuria 1.1g/24hr. Normal renal
function, creatinine 80. ANA, ANCA and Anti GBM negative. Complement,
Immunoglobulins, electrophoresis negative. Hep B/C negative. IgG, M and
C3c essentially negative.
Specimen:
H&E & Silver Photos of IF x 5
Diagnostic categories: Score:
1 IgA nephropathy 9.97
2 IgA nephropathy AND membranous nephropathy 0.03
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 9.97
Secondary diagnoses and comments (if any):
EM*5. Focal ATN*1. Hypertension too*1.
Original report and further information (if any):
IgA nephropathy, mild mesangial proliferative pattern.
Circulation: U
Case number: 249
....
Number of responses:87 . Date of analysis: 31 DEC 05
Clinical:
61 y.o. male. Membranous nephropathy. Presented with doubling proteinuria.
Creatinine 90-200. Low grade IgM paraprotein (MGW) doubled with IgG
immunoparesis. Anaemia. Previous light chain on urine immunofixation in
2003. ?Cause of nephrotic syndrome. NB N renal USS.
Specimen:
H&E, Silver, Photos of EM, Photos of IPX
Diagnostic categories: Score:
1 Membranous Gn 5.76
2 Interstitial nephritis 0.06
3 Membranous Gn and interstitial nephritis 2.64
4 Membranous Gn and paraprotein / myeloma casts 0.34
5 Membranous pattern Lupus nephropathy 0.74
6 Membranous Gn and macro/cryoglobulinaemia 0.23
7 Membranous Gn c/w Sjogren's syndrome 0.11
8 Secondary membranous Gn 0.11
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 5.76
Secondary diagnoses and comments (if any):
Investigations for myeloma/lymphoma*23. Cryoglobulin?*3. Lupus serology?*
19. Renal vein thrombosis?*1. Drug history?*3. PAS*3. K&L*6. Congo red*8.
More EM*3.Tip lesions present*1. Drug history?*2. UCryo?*1. Unsuitable for
EQA*2.
Original report and further information (if any):
Membranous glomerulonephritis. No further information.
Circulation: U
Case number: 250
....
Number of responses:87 . Date of analysis: 31 DEC 05
Clinical:
Male, 76 y.o. Acute renal failure with blood (+++) and protein (+++) in
urine by dipstix.
Specimen:
H&E, PAS
Diagnostic categories: Score:
1 Myeloma cast nephropathy 7.93
2 Myeloma cast nephropathy and ATN 0.80
3 Myeloma cast nephropathy and ?acute pyelonephritis 1.15
4 Interstitial nephritis and myeloma kidney 0.11
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 7.93
Secondary diagnoses and comments (if any):
Congo red*10. Exclude ascending infection*15. Tests to confirm myeloma*22.
EM*4. Silver*1. IF*1.
Original report and further information (if any):
Circulation: U
Case number: 251
....
Number of responses:87 . Date of analysis: 31 DEC 05
Clinical:
56 y.o. female. Known diabetic with chronic renal failure and deterioration
in renal function. EM not known. Immunology showed few mesangial
granular/globular deposits of IgA 2+ and sparse IgM 1+.
Specimen:
H&E, Silver
Diagnostic categories: Score:
1 Diabetes, IgA neph and interstitial nephritis 4.14
2 Diabetes and IgA neph 0.80
3 Diabetes and interstitial nephritis 2.41
4 IgA neph and interstitial nephritis 1.38
5 Diabetes 0.23
6 IgA nephropathy 0.11
7 Interstitial nephritis 0.23
8 Diabetes, IgA neph and ascending infection 0.11
9 TIN, pyelonephritis, diabetes AND IgA neph. 0.46
10 Acute pyelonephritis 0.11
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 4.14
Secondary diagnoses and comments (if any):
Exclude myeloma*1. Exclude ascending infection*17. EM*20. PAS*1 Congo
red*1.Drug reaction?*8. Relevance of IgA?*8. Need to see IF*9. ANCA?*4.
ANA*1. Serum IgA?*1. Blood eosinophilia?*1. Proteinuria?*2. Haematuria?*
1. Unsuitable for EQA?*1.
Original report and further information (if any):
Tubulo-interstitial nephritis, background diabetic glomerulonephropathy and
probable hypertension.
Circulation: U
Case number: 252
....
Number of responses:87 . Date of analysis: 31 DEC 05
Clinical:
50 year old female. Increased Ca 2+. Cr 250. BHL. Sarcoidosis.
Creatinine 280. BP 100/70. IF: Glomeruli negative. Coarse IgM and C3 in
walls of arterioles and larger vellels. Casts in DCTs positive for IgA.
Kappa and Lambda equal.
Specimen:
H&E, PAS
Diagnostic categories: Score:
1 Interstitial neph ? sarcoid 7.93
2 Interstitial neph., differential given 0.11
3 Interstitial nephritis 0.00
4 Sarcoid 1.03
5 Granulomatous interstitial nephritis 0.80
6 Cast nephropathy 0.11
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 7.93
Secondary diagnoses and comments (if any):
Exclude drugs*6. Various stains for various organisms *17. EM*2. Other
IF results?*1. Exclude myeloma*1. What's 'BHL'?*3.
Original report and further information (if any):
Granulomatous interstitial nephritis in keeping with sarcoidosis.
Circulation: U
Case number: 253
....
Number of responses:87 . Date of analysis: 31 DEC 05
Clinical:
76 y.o.female. Nephrotic syndrome, proteinuria 7g/24hr, urea 10, creatinine
222. IF: Faint positivity with IgG, A, M, Kappa, C3. Lambda strong +ve
gloms, vessels & focally interstitium.
Specimen:
H&E, PAS, Photos of Congo Red
Diagnostic categories: Score:
1 Amyloidosis 9.89
2 Light chain disease 0.11
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 9.89
Secondary diagnoses and comments (if any):
Presumably AL type*30. Investigate amyloid type*10. Investigations for
myeloma*10. EM*6.
Original report and further information (if any):
Links to cases in this document:
Top
U 248
U 249
U 250
U 251
U 252
U 253
Last updated: 31 DEC 05
Organiser:
Professor Peter Furness, PhD, FRCPath.
Department of Pathology
Leicester General Hospital
Gwendolen Road
Leicester
LE5 4PW, U.K.
Tel: (0116)2584582
Fax: (0116) 2584582
Email:
peter.furness@le.ac.uk
