National Renal Pathology E.Q.A. Scheme
Circulation S
This document gives information on individual cases in circulation S of this scheme.
It contains no personal details of participants.
Cases included:
S 91
S 92
S 93
S 94
S 95
S 96
End
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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: S
Case number: 91
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Number of responses:59 . Date of analysis: 17 APR 97
Clinical:
FOR EDUCATION & INTEREST, NOT FOR PERSONAL ASSESSMENT Insulin dependent
diabetes for some years but with minimal retinopathy. Recent onset of
nephrotic syndrome. 6.5 g proteinuria, albumin 25, creatinine 72. IPx for
immunoglobulinss all negative. N.B. deposits illustrated on e.m. were NOT
Diagnostic categories: Score:
1 Diabetic changes 5.08
2 Mesangiocapillary glomerulonephritis 3.36
3 Light chain nephropathy 0.34
4 Immune complex Gn N.O.S. 0.46
5 FSGS 0.10
7 SLE 0.03
8 C3 mesangial disease 0.12
10 No diagnosis offered 0.51
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 5.08
Secondary diagnoses and comments (if any):
EM deposits due to fibrin?*4. 'Diabetes with dense deposits' *8.
Complement level?*1. Minimal change nephropathy too?*1. Light chain
nephropathy?*1. Kappa & lambda?*1. Focal tubular necrosis*1.
Original report and further information (if any):
Circulation: S
Case number: 92
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Number of responses:66 . Date of analysis: 17 APR 97
Clinical:
Diagnostic categories: Score:
1 Membranous glomerulonephritis 8.03
2 Cryoglobulinaemia 0.02
3 Lupus nephritis (Merge with 1??) 1.92
4 Gold nephropathy (Merge with 1??) 0.03
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 8.03
Secondary diagnoses and comments (if any):
Poor IgG*10. More immuno.*6. Need e.m.*11. Memb. 2ry to gold?*13. 2ry to
lupus?*28. Proliferation - unusual in membranous*2. Inadequate for EQA*1.
?hyaline thrombi or artefact? IgG subclass?*1. Exclude amyloid*2
Original report and further information (if any):
Circulation: S
Case number: 93
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Number of responses:64 . Date of analysis: 17 APR 97
Clinical:
40 y.o. woman. institutional
Diagnostic categories: Score:
1 Acute interstitial nephritis 9.16
2 Myeloma kidney 0.20
3 Light chain nephropathy 0.16
4 Acute pyelonephritis 0.16
5 Chronic pyelonephritis 0.25
6 Acute pyelonephritis 0.08
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 9.16
Secondary diagnoses and comments (if any):
I.N. due to cimetidine?*19. Drugs?*14. Part of mental deficiency
syndrome?*1. Exclude myeloma*6. Exclude UTI*16. Exclude amyloid*2.
Exclude lupus*1. Myeloma kidney and light chain nephropathy*1.
Granulomas*1. Inadequate for EQA*1.
Original report and further information (if any):
Circulation: S
Case number: 94
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Number of responses:66 . Date of analysis: 17 APR 97
Clinical:
Male, 42. Haematuria and proteinuria. Previous haemoptysis and left sided
chest pain. Paraprotein found. Immunofluorescence negative.
Macro:
H&E, Silver, E.M. prints*5 (please leave stapled together; they are not
separately labelled)
Diagnostic categories: Score:
1 Fibrillary / immunotactoid glomerulonephritis 3.42
2 MCGn with fibrillary deposits 0.53
3 Cryoglobulinaemia / dysproteinaemia / gammopathy 3.76
4 Proliferative Gn with fibrillary deposits 0.27
5 Proliferative glomerulonephritis 0.30
6 Amyloidosis 0.30
7 Mesangiocapillary pattern 2ry to cryo. 0.45
8 SLE 0.21
9 Light chain disease 0.76
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 3 with 3.76
Secondary diagnoses and comments (if any):
Repeat IF, should be positive*6. Kappa & lambda*2. Amyloid?*10. Measure
fibril width (no scale provided)*4. ATn too*1. IgG subtype?*1.
Original report and further information (if any):
Circulation: S
Case number: 95
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Number of responses:66 . Date of analysis: 17 APR 97
Clinical:
Female born 1919. Chronic renal impairment last few years; abrupt
deterioration 1 month before biopsy. Long-term NSA
Diagnostic categories: Score:
1 Myeloma kidney 7.79
2 Interstitial nephritis 1.44
3 Analgesic nephropathy 0.15
5 Acute tubular necrosis 0.42
6 Amyloidosis 0.20
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 7.79
Secondary diagnoses and comments (if any):
Amyloid stain*16. Immunoelectrophoresis, kappa & lambda, bone marrow
etc.*19 . Hypertensive / ischaemic vascular changes*5. ATN too*2. IF?*1.
Sarcoid?*2. Granulomatous inflammation*1. K deficiency?*1.
Original report and further information (if any):
Circulation: S
Case number: 96
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Number of responses:66 . Date of analysis: 17 APR 97
Clinical:
52 y.o. male admitted for thyroidectomy for papillary carcinoma.
Biochemical investigations revealed impaired renal function with a
creatinine of 581, urea of 25. Immunofluorescence studies were all negative.
(E.M. not mentioned)
Specimen:
H&E, PAS
Diagnostic categories: Score:
1 Interstitial nephritis 5.68
2 Pyelonephritis (infection) 0.76
3 Interstitial nephritis and infection both mentioned 3.18
4 Hypertension 0.08
5 Diffuse infiltration by carcinoma from thyroid 0.15
6 Myeloma kidney 0.15
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 5.68
Secondary diagnoses and comments (if any):
Drug history?*18.
Original report and further information (if any):
Links to cases in this document:
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S 91
S 92
S 93
S 94
S 95
S 96
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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