National Renal Pathology E.Q.A. Scheme
Circulation Q
This document gives information on individual cases in
circulation Q of this scheme. It contains no personal details
of participants.
Cases included:
Q 224
Q 225
Q 226
Q 227
Q 228
Q 229
End
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illustrate the relevant features of the material which was
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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: Q
Case number: 224
....
Number of responses:74 . Date of analysis: 14 AUG 04
Clinical:
49yr old female. H/O systemic sclerosis, 'myositis' and myocardial
infarction. Recent renal impairment. Urea 9.7, Creatinine 121, Creatinine
clearance 42, Urinary protein 3.3g/24hr. Serology: ANA positive 1/>2560 (
speckled pattern). dsDNA negative. Anti-ribonuclear protein (nRNP)
positive.
Specimen:
H&E, PAAg, Photo's Fluorescence *6, EM
Diagnostic categories: Score:
1 Lupus nephritis NOS 0.61
2 Lypus nephritis IV 1.55
3 Lupus nephritis WHO III 0.54
4 Mixed connective tissue disease (Lupus-like) 3.11
5 Lupus nephritis, crescentic / necrotising 2.09
6 Crescentic (vasculitic) 'immune' Gn 0.41
7 Necrotising IgA nephropathy 0.14
8 Consistent with systemic sclerosis 0.54
9 Crescentic / necrotising Gn NOS 0.95
10 Cryoglobulinaemia 0.07
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 4 with 3.11
Secondary diagnoses and comments (if any):
IF prints inadequate*8. More EM photos*1. ANCA?*5. Anti-GBM serology?*1.
Exclude cryoglobulin*3. Unsuitable for EQA unless generic diagnosis OK*1.
Original report and further information (if any):
Necrotising glomerulonephritis in mixed connective tissue disease
Circulation: Q
Case number: 225
....
Number of responses:74 . Date of analysis: 14 AUG 04
Clinical:
Female 32 yrs. Presented with ?acute renal failure. Serum creatinine 948.
Urine dipstick 3+ protein, 3+ glucose. Some weeks prior to admission
suffered a number of boils treated with antibiotics. Direct IF showed weak
staining for C3 within the mesangium of the glomeruli and some tubular casts
stained with IgA. Otherwise IgA, IgG and IgM negative. EM not performed.
Specimen:
H&E, PAS
Diagnostic categories: Score:
1 Interstitial nephritis, exclude pyelonephritis 1.08
2 Interstitial nephritis NOS 7.43
3 Drug-induced TIN (i.e. definite cause stated) 0.14
4 Nephronophthisis 0.14
5 Tubular necrosis 0.14
6 Diabetes &TIN 0.59
7 Glomerulonephritis (various forms) & TIN 0.22
8 Granulomatous interstitial nephritis 0.14
10 No response received 0.14
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 2 with 7.43
Secondary diagnoses and comments (if any):
Drug related?*34. Also mild resolving post-infectious Gn*1. EM*6. Exclude
similtaneous minimal change*1. ATN too*2. Granulomas present*1. Exclude
pregnancy*1. Exclude diabetes*6. Exclude myeloma*3. Exclude lymphoma*1.
Congo Red*3. Silver*2.
Original report and further information (if any):
Circulation: Q
Case number: 226
....
Number of responses:74 . Date of analysis: 14 AUG 04
Clinical:
Male, 62 yrs. Presented with malaise, anaemia and severely abnormal renal
function tests. HB10, ESR 67, urea 14, creatinine 261, paraprotein. ?
Myeloma.
Specimen:
H&E, PAAg
Diagnostic categories: Score:
1 Myeloma (cast nephropathy) 8.78
2 Myeloma cast nephropathy ??? malignant infiltrate too 1.08
3 Pyelonephritis 0.14
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 8.78
Secondary diagnoses and comments (if any):
Congo red *14. PAS*2. Kappa & lambda immuno.*11. EM*2.
Immunoelectrophoresis*5.
Original report and further information (if any):
Circulation: Q
Case number: 227
....
Number of responses:74 . Date of analysis: 14 AUG 04
Clinical:
Female 37yrs. Obese with h/o uveitis treated with topical then later oral
steroids. Subsequently presented in acute renal failure six weeks later.
Now dialysis dependent. Urine dipstick analysis showed blood and protein.
Specimen:
H&E, PASD
Diagnostic categories: Score:
1 Tubulo-interstitial nephritis & uveitis (Dobrin's syndr.7.03
2 Interstitial nephritis NOS 2.84
3 Drug-induced tubulo-interstitial nephritis 0.14
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 7.03
Secondary diagnoses and comments (if any):
?drug induced*11. Exclude toxoplasmosis*4. ?Bechet's*3 ?sarcoid*7. ?
Sjogren's*1. ?vasculitis*2. Consider various rare infections*4. Exclude
UTI*2. Eosinophilia?*1. Churg-Strauss?*1. Bone marrow*1. Granulomas
present*2. H&E missing*3.
Original report and further information (if any):
Circulation: Q
Case number: 228
....
Number of responses:74 . Date of analysis: 14 AUG 04
Clinical:
Male, 69 yrs. Membranous nephropathy 1987 - remission over last few months.
Significant proteinuria (nephrotic) ?recurrence membranous. IF - strong
granular capillary loop IgG.
Specimen:
H&E, PAS Meth Ag, Photo EM
Diagnostic categories: Score:
1 Membranous glomerulonephritis 10.00
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 10.00
Secondary diagnoses and comments (if any):
Atheroembolus noted*1. EM*2. Congo red*1. Exclude secondary membranous*1.
Original report and further information (if any):
Membranous nephropathy
Circulation: Q
Case number: 229
....
Number of responses:74 . Date of analysis: 14 AUG 04
Clinical:
Female, 66 yrs. Acute renal failure. Previously well. ?Vasculitis.
Immunostaining negative.
Specimen:
H&E, PAS
Diagnostic categories: Score:
1 Interstitial nephritis 2.97
2 Interstitial nephritis and ATN 1.22
3 Interstitial nephritis, exclude infection 4.59
4 Granulomatous interstitial nephritis 0.68
5 Acute pyelonephritis 0.14
6 ATN with interstitial nephritis 0.14
7 Myeloma kidney 0.14
8 Exclude infection, the treat as TIN 0.14
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 3 with 4.59
Secondary diagnoses and comments (if any):
Exclude myeloma*5. Thick section*1. RBCs in tubules - consider necrotising
Gn not in sections provided*3. EM to exclude GBM abnormality*1. Granuloma
present - do Z-N*7. Stain for fungi*1. Clinical info?*2. Drugs?*10.
Sarcoid?*3. Urine culture?*6. Autoantibodies?*1. Lupus serology*1. ANCA*1.
Lymphoma?*1.
Original report and further information (if any):
Links to cases in this document:
Top
Q 224
Q 225
Q 226
Q 227
Q 228
Q 229
Last updated: 14 AUG 04
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
