National Renal Pathology E.Q.A. Scheme
Circulation F
This document gives information on individual cases in
circulation F of this scheme. It contains no personal details
of participants.
Cases included:
F 170
F 171
F 172
F 173
F 174
F 175
End
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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 an 'aide
memoire' for participants who may no longer have the slides for
review.
They are NOT intended as 'good examples' or as
teaching material. Some of the images may be chosen to
illustrate a feature which led some participants to a
wrong diagnosis.
Case Response Analysis
Circulation: F
Case number: 170
....
Number of responses:75 . Date of analysis: 19 DEC 01
Clinical:
38 y.o. woman, recent onset renal impairment, creatinine 193, 1+ haematuria,
2+ proteinuria. No relevant past medical history.
Specimen:
H&E, PAS
Diagnostic categories: Score:
1 Acute interstitial nephritis 5.35
2 Chronic interstitial nephritis 0.00
3 Interstitial nephritis NOS 4.24
4 Acute tubular necrosis 0.12
5 Focal segmental glomerulosclerosis 0.13
6 Acute eosinophilic interstitial nephritis 0.13
7 Mesagnial proliferative glomerulonephritis 0.03
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 5.35
Secondary diagnoses and comments (if any):
?drugs*49. Herbs?1. Infections?*1. Immuno*3. EVG*1. Clinical info*2.
Exclude UTI*1. Exclude Churg Strauss*2.
Original report and further information (if any):
Acute interstitial nephritis. Treated with steroids. Full recovery of
normal renal function.
Circulation: F
Case number: 171
....
Number of responses:75 . Date of analysis: 19 DEC 01
Clinical:
Female aged 34. Occasional episodes of macroscopic haematuria associated
with loin pain. Normal renal function. Urine: persistent microhaematuria,
no significant proteinuria. Immunoperoxidase negative IgG, A, M & C3. EM
final magnification x6000
Specimen:
H&E, PAS, EMx1
Diagnostic categories: Score:
1 Thin membrane nephropathy 9.55
2 Benign familial haematuria 0.00
3 Normal (including BM thickness) 0.13
4 Normal (BM thickness not mentioned) 0.00
5 Loin pain - haematuria syndrome 0.19
6 Normal (pending proper BM measurement) 0.13
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 9.55
Secondary diagnoses and comments (if any):
Need scale on EM / method of measurement*17. Unsuitable for EQA without
scale*3. Can't exclude loin pain - haematuria syndrome *3. Angiogram?*1.
Family history?*6.
Original report and further information (if any):
Thin membrance nephropathy (measured at 208nm by method of McLay)
Circulation: F
Case number: 172
....
Number of responses:75 . Date of analysis: 19 DEC 01
Clinical:
77 y.o. female. PMH of asthma (6 years). Now 1/12 history of general
malaise, nausea and anorexia. Creat. 110-376. Hb decreased 9.1, CRP 190,
ESR 90, urine protein + blood +++. Granular casts. Mild eosinophilia. ?
vasculitis ?Churg-Strauss
Specimen:
H&E
Diagnostic categories: Score:
1 Arteritis 0.53
2 Arteritis ? Churg Strauss 8.61
3 Acute interstitial nephritis 0.81
4 Post-infective Gn 0.04
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 2 with 8.61
Secondary diagnoses and comments (if any):
ANCA*14, EVG*4, MSB*4, Silver*5, PAS*2. Levels*1. IF*4. EM*1. Serology*1.
Drug history?*2. Exclude lymphoma*1. Inadequate material *3.
Original report and further information (if any):
Arteritis and tissue eosinophilia consistent with Churg-Strauss syndrome.
Circulation: F
Case number: 173
....
Number of responses:75 . Date of analysis: 19 DEC 01
Clinical:
Male, dob 1955, who presented with pneumonia and renal failure. CXR showed
LVH. Hypertensive, on treatment. Immunology negative. Immunoperoxidase
showed strong IgM and complement within blood vessel walls. EM showed
wrinkled peripheral loops but no deposits.
Specimen:
H&E, Trichrome
Diagnostic categories: Score:
1 Vasculopathy c/w severe hypertension 6.23
2 Microangiopathy, differential given 2.53
3 Systemic sclerosis 0.67
4 Haemolytic uraemic syndrome 0.13
5 Primary FSGS, 2ry hypertension 0.04
6 Benign nephrosclerosis 0.13
7 Malignant nephrosclerosis 0.27
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 6.23
Secondary diagnoses and comments (if any):
EVG*1. PAS*1. SIlver*1. Exclude scleroderma*6. Actual BP?*2. Serology*1.
Exclude acute pyelonephritis too*4. Exclude antiphospholipid syndrome*1.
Exclude amyloid*1. Any haemolysis?*2. Immuno*1. EM*1. More clinical info *
2.
Original report and further information (if any):
Accelerated hypertension. No serological or clinical evidence of
vasculitis or scleroderma.
Circulation: F
Case number: 174
....
Number of responses:75 . Date of analysis: 19 DEC 01
Clinical:
39 year old female. Nephrotic syndrome, normal creatinine, nornal size
kidneys. PMH nil of note. Clinically ?minimal change disease. Immuno.:
Thickened basement membranes with heavy deposition of IgG, similar amounts
of granular IgA and C3, same location.
Specimen:
H&E, PAAg
Diagnostic categories: Score:
1 Mesangiocapillary Gn type I (?III) 4.49
2 Mesangiocapillary Gn type II 0.20
3 Mesaniocapillary Gn ? cryoglobulinaemia 0.40
4 Mesangiocapillary Gn ? secondary 0.67
5 Mesangiocapillary Gn NOS 2.27
6 IgA nephropathy 0.72
7 SLE (mesangiocapillary pattern) 0.99
8 Diffuse endocapillary Gn ?SLE 0.13
9 Mesangial proliferative Gn 0.13
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 4.49
Secondary diagnoses and comments (if any):
Exclude cryoglobulinnaemia/paraprotein*8. Lupus serology *23. Hep. C status
*1. EM*10. Rest of IF?*1. C1q?*1. Serum IgA*1. Unsuitable for EQA without
EM*2.
Original report and further information (if any):
Membrano-proliferative glomerulonephritis, consistent with lupus nephritis,
WHO class III.
Circulation: F
Case number: 175
....
Number of responses:57 . Date of analysis: 19 DEC 01
Clinical:
27y.o. Ugandan female with nephrotic syndrome, haematuria but normal
creatinine. Immunoperoxidase: IgA-, IgG- (but ? reliable), IgM++, C1q++,
C3b+, C4 trace, all mesangial and peripheral.
Specimen:
H&E, EM x2
Macro:
EDUCATION AND INTEREST, NOT FOR PERSONAL SCORING.
Diagnostic categories: Score:
1 Collapsing glomerulopathy (+/- ?HIV) 1.46
2 Minimal change nephropathy 0.25
3 Malarial nephropathy 0.79
4 HIV associated nephropathy 5.35
5 MPGn 0.54
6 Glomerulopathy NOS 0.53
7 IgM nephropathy 0.84
8 Membranous Gn 0.18
9 Diabetes 0.07
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 4 with 5.35
Secondary diagnoses and comments (if any):
HIV status?*14. Exclude myeloma*2. Exclude cryo*2. EM search for tubulo-
reticular inclusions*2. Lupus serology*3. Schistosomiasis???*1.
Original report and further information (if any):
Probably HIV-associated nephropathy; serological tests indicated.
Links to cases in this document:
Top
F 170
F 171
F 172
F 173
F 174
F 175
Last updated: 19 DEC 01
Organiser:
Dr Peter Furness, PhD, FRCPath.
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.ac.uk
