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 
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
....
....
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
....
....
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
....
....
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
....
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. -->
....
....
....
