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Renal EQA Circulation L
This document gives information on individual cases in circulation L of this scheme. It contains no personal details of participants.

Cases included:

L 57
L 58
L 59
L 60
L 61
End

A click on the [Microscope] 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: L

Case number: 57 .... [Microscope] .... [Microscope]


Number of responses:56 . Date of analysis: 1 JUN 95

Clinical:

Male, 59, recent onset of nephrotic syndrome. IF sample contained no glomeruli.

Macro:

H&E, Meth Ag., em prints x2. 
Diagnostic categories:                         Score:
 1  Membranous glomerulonephritis                           9.29
 2  Focal segmental glomerulosclerosis                      0.07
 3  Minimal change nephropathy                              0.29
 4  Mesangiocapillary glomerulonephritis                    0.18
 5  Focal segmental proliferative gn.                       0.18
 6  Mesangial proliferative glomerulonephritis              0.00
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 9.29

Secondary diagnoses and comments (if any):

Need immonoperoxidase*7. Fibrin stain*1. SLE?*6. Underlying cause?*6. Penicillamine Rx?*2. Tubular damage noted *2. Iron in tubules?*1. Capillary microthrombi ?microangiopathy*2. Segemental proliferation?*1. More/better e.m.*2. Cryoglobulin?*1. Drug history?*1.

Original report and further information (if any):

Initial diagnosis equivocal, but e.m. confirmed early membranous glomerulonephritis. Treated with steroids. Oedema & proteinuria resolved; creatinine 112 when last seen.

Circulation: L

Case number: 58 .... [Microscope] .... [Microscope]


Number of responses:56 . Date of analysis: 1 JUN 95

Clinical:

Male, 54. Steroids & dapsone for 'panniculitis' years ago. 4 weeks ill health & upper abdo pain. Kidney resected; normal size but surrounded by haemorrhage. Haemorrhages 3-4mm across in cortex. IF: segmental granular IgM, C3, C1q. IgG & A negative. C1q in arterioles. Fibrinogen present in ve

Macro:

H&E x2 from nephrectomy 
Diagnostic categories:                         Score:
 1  Necrotising glomerulonephritis / vasculitis             8.59
 2  Allergic interstitial nephritis                         0.25
 3  FSGS                                                    0.45
 4  Ascending pyelonephritis                                0.07
 5  SLE                                                     0.20
 6  End stage kidney                                        0.23
 7  Myeloma                                                 0.02
 8  Glomerulonephritis of infective endocarditis            0.14
 9  Malignant hypertension                                  0.04
 10 Cryoglobulinaemia                                       0.02
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 8.59

Secondary diagnoses and comments (if any):

ANCA?*18. Anti-GBM? *1. Rheumatoid?*1. Churg Strauss?*6. Was 'panniculitis' vasculitic?*1. Why nephrectomy?*1. Acute pyelo. too? *3. Secondary interstitial nephritis*2. Hypertension too*2. ATN too*1. Renal vein thrombosis *2. Ruptured aneurysm*1. Exclude fungi*1. Lupus serology*2. E.M.*4. Silver stain*2. Elastin *9. PAS*2. Congo red*1. More clinical in

Original report and further information (if any):

Diagnosis: Necrotising vasculitis, presumably PAN. Perinephric haemorrhge due to ruptured arcuate artery aneurysm. Stormy course, required immunosuppression, ventilation, dialysis; had myoclonic jerks. Some renal function recovered, off dialysis. Then ileo-femoral thrombosis; anticoagulated. ANCA negative by fluorescence and ELISA.

Circulation: L

Case number: 59 .... [Microscope]


Number of responses:56 . Date of analysis: 1 JUN 95

Clinical:

22 yo female, atopic, 16y insulin dependent diabetes. Recent onset proteinuria, hypertension, falling GFR. Clinical differential: Diabetic nephropathy? Interstitial nephritis? Churg-Strauss? Immunoperoxidase negative. Congo red negative. E.M. not available.

Macro:

H&E x 1 
Diagnostic categories:                         Score:
 1  Diabetic nephropathy                                    9.48
 2  Churg-Strauss                                           0.18
 3  Fibrillary glomerulonephritis                           0.02
 4  Light chain nephropathy                                 0.05
 5  Amyloid despite negative Congo Red                      0.02
 6  Mesangiocapillary glomerulonephritis                    0.02
 7  Interstitial nephritis ?due to allergy or Churg Strauss 0.23
 9  ...                                                     0.00
 10 (7 to be merged with something??)                       0.00
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 9.48

Secondary diagnoses and comments (if any):

Meth. Ag*5. Masson trichrome *2. PAS*2. Congo red*1. Immuno needed*1. Reprocess for e.m.*4. Eosinophils-?allergic interstitial nephritis too?*9. Crystals?*1. Unsuitable case / inadequate material *2.

Original report and further information (if any):

Changes consistent with longstanding diabetes mellitus. Subsequently treated for hypertension. Peripheral eosinophilia declined - atopy related?

Circulation: L

Case number: 60 .... [Microscope] .... [Microscope]


Number of responses:56 . Date of analysis: 1 JUN 95

Clinical:

51y.o. woman with rheumatoid arthritis for 10 y. Given gold previously. Proteinuria 4.2g/24h. Current treatment Atenolol, NSAID. Immunoperoxidase; no detectable Ig or complement. Congo red negative.

Macro:

H&E, PAS, Hexamine silver, E.M. prints x4 (stapled together) 
Diagnostic categories:                         Score:
 1  Membranous glomerulonephritis (+/- comments about gold) 9.58
 2  Focal segmental glomerulosclerosis                      0.06
 3  Rheumatoid nephropathy                                  0.18
 4  Mesangial proliferative gn.                             0.18
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 9.58

Secondary diagnoses and comments (if any):

Gold in tubules on e.m.*48. Why e.m. of tubules? *1. Repeat immuno, should be positive! *9. Negative immuno because gold stopped, lesion regressing?*1. Giant cells in tubules ?virus *1.

Original report and further information (if any):

Membranous glomerulonephritis, stage 1, associated with gold therapy.

Circulation: L

Case number: 61 .... [Microscope] .... [Microscope]


Number of responses:56 . Date of analysis: 1 JUN 95

Clinical:

PUO, longstanding joint symptoms, increasing renal impairment - creatinine 460. ANF negative, ANCA awaited. IF: glomeruli negative to all Ig classes. Fibrinogen ++ in glomeruli.

Macro:

H&E, Meth Ag. 
Diagnostic categories:                         Score:
 1  Pauci-immune necrotising / crescentic glomerulonephritis9.66
 2  Focal segmental glomerulonephritis                      0.25
 3  Thrombotic microangiopathy                              0.09
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 9.66

Secondary diagnoses and comments (if any):

ANCA?*18. Anti-GBM?*1. Rheumatoid factor?*1. Clinical info.? *8. E.M. needed*3. MSB*2. ATN too*1. Interstitial nephritis too *1. Consider SBE*1.

Original report and further information (if any):

Links to cases in this document:
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L 57
L 58
L 59
L 60
L 61

[Leicester University] [] Pathology EQA
Last Updated: June 1995
Peter Furness, Department of Pathology, University of Leicester.