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 236
S 237
S 238
S 239
S 240
S 241
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: S
Case number: 236
....
Number of responses:72 . Date of analysis: 24 APR 05
Clinical:
From overseas. 12 y.o fem. Referred with nephrotic syndrome, hypertension
& microhaematuria for 1mth. Proteinuria 2.5gm, serum alb 19g/l, cholesterol
7mmol/l. Normal blood urea & serum creatinine levels. C3, C4 low.
Cryoglobulin neg. TFT normal. Antiphospholipid antibody neg. ALT 150iu/l,
bilirubin N. Liver bx - chronic hepatitis with features consistent with
cirrhosis. IF - Granular capillary & mesangial deposits of C3c(3+), C1q(3+),
IgM(3+), IgA(2+), IgG(2+)
Specimen:
H&E, Silver, Photo of EM
Macro:
For educational interest only.
Diagnostic categories: Score:
1 IC-mediated Gn, ? lupus 5.04
2 Mesangiocapillary Gn 3.09
3 Post-infectious (proliferative) Gn 0.21
4 Membranous Gn 0.97
5 IgA nephropathy 0.15
6 Dense deposit disease 0.07
7 Cryoglobulinaemia 0.03
8 Lupus (and storage disease) 0.14
9 C1q nephropathy 0.02
10 IC-mediated Gn, 2ry to Hep.B 0.28
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 5.04
Secondary diagnoses and comments (if any):
Hepatitis status?*24. Malaria?*4. Lupus serology?*18. HIV?*2.
Schistosomiasis?*1. Inherited complement abnormality?*1. More EM*3. Repeat
test for cryoglobulin!*2. Alpha-1 antitrypsin deficiency?*1.
'Mixed mesangiocapillary and membranous' (*4) - coded as mesangiocapillary
Original report and further information (if any):
Case submitted by Professor Date from Oman who has since left the scheme
Circulation: S
Case number: 237
....
Number of responses:77 . Date of analysis: 24 APR 05
Clinical:
Female, 29 y.o. Creatinine 140, proteinuria, pericarditis, ?lupus
nephritis. IF - granular capillary loop and mesangial IgG, IgM, IgA, C3,
C1q.
Specimen:
H&E. Meth Ag.
Diagnostic categories: Score:
1 Lupus class IV, G, A 6.49
2 Lupus class IV, G, A/C 1.43
3 Lupus class IV NOS 0.90
4 Lupus class IV, S, A/C 0.13
5 Lupus class II 0.39
6 Post-infectious Gn 0.01
7 Lupus class IV G (A & C not mentioned) 0.26
8 Lupus class IV A (G & S not mentioned) 0.13
9 Lupus class IV C (G & S not mentioned) 0.26
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 6.49
Secondary diagnoses and comments (if any):
Lupus serology*10. Exclude sepsis-related Gn*2. Element of lupus V too?*1.
Not enough glomeruli to classify *4. Acute pyelonephritis too*1. Possible
vasculitis too?*1. EM*2. Trichrome*1.
Original report and further information (if any):
IF your diagnosis is lupus, please use the ISN/RPS classification - see
Kidney International 64:521-530, 2004 - PF
Circulation: S
Case number: 238
....
Number of responses:78 . Date of analysis: 24 APR 05
Clinical:
Female, 42 y.o. Microscopic haematuria, proteinuria, normal renal function,
normal immunological investigations.
Specimen:
H&E, IgA
Diagnostic categories: Score:
1 IgA nephropathy 8.46
2 IgA nephropathy + comment about mild, ?significance 1.54
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 8.46
Secondary diagnoses and comments (if any):
What did the rest of the immuno. show?*8. EM*7. ATN too*1.
Original report and further information (if any):
Circulation: S
Case number: 239
....
Number of responses:78 . Date of analysis: 24 APR 05
Clinical:
Male. 29 y.o. AIDS diagnosed one year ago - high viral load + resistance/
non-compliance with antivirals. ARF - creatinine 600, normal one year ago;
nephrotic; haematuria; on no medication at time of biopsy. No material
retained for immunofluorescence.
Specimen:
H&E, Silver
Diagnostic categories: Score:
1 HIVAN 9.36
2 Collapsing glomerulopathy 0.38
3 Segmental Gn, ?collapsing 0.13
4 Granulomatous TIN & FSGS/MCGn-like Gn 0.13
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 9.36
Secondary diagnoses and comments (if any):
PAS*2. Masson*1. EM*6. Z-N*1. Giemsa*1. Tubulo-reticular inclusions?*2.
Immunoperoxidase*3. ATN too*6. Exclude polyoma virus*2. CMV inclusions
too?*2. Heroin abuse?*1. Unsuitable for EQA*1.
Original report and further information (if any):
Circulation: S
Case number: 240
....
Number of responses:78 . Date of analysis: 24 APR 05
Clinical:
Age and Sex not stated. Creatinine 135, proteinuria 3.5g/day. ANCA
negative. Microscopic haematuria, C3 = 0.75, C4 = 0.19. Hypertensive. IF
showed six glomeruli per section which show mesangial IgA only. EM showed
expanded mesangial areas with mild mesangial cell proliferation. Plentiful
dense deposits in mesangial and paramesangial areas.
Specimen:
H&E
Diagnostic categories: Score:
1 IgA nephropathy 9.39
2 IgA nephropathy and microangiopathy 0.38
3 Immunoglobulin deposition disease 0.13
4 Cryoglobulinaemia 0.03
5 Light chain glomerulopathy 0.03
6 Amyloid 0.03
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 9.39
Secondary diagnoses and comments (if any):
Hypertension too*12. Cryo???*1. ATN too*2. PAS*2. Silver stain*1. Congo
red*1. Relevance of calcium?*1. Serum & urine electrophoresis*1.
Original report and further information (if any):
Circulation: S
Case number: 241
....
Number of responses:77 . Date of analysis: 24 APR 05
Clinical:
Female, 46 y.o. Arthralgia, rash, active sediment with 2g/24 hrs
proteinuria, normal renal function. Weak positive ANA. ?Lupus.
Specimen:
H&E, PAAG and 5 photos of immuno.
Diagnostic categories: Score:
1 Lupus IV S, A 1.04
2 Lupus II 1.36
3 Lupus III A/C 1.56
4 Lupus IV, S, A/C 0.78
5 Lupus IV, G, A/C 2.21
6 Lupus III A 1.43
7 Lupus IV G, A 0.78
8 Lupus IV NOS 0.32
9 Lupus III NOS 0.45
10 HSP/IgA nephropathy 0.06
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 5 with 2.21
Secondary diagnoses and comments (if any):
Further lupus serology*3. EM*4. trichrome*1.
Original report and further information (if any):
Lupus nephritis WHO class IVa
Links to cases in this document:
Top
S 236
S 237
S 238
S 239
S 240
S 241
Last updated: 24 APR 05
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
