National Renal Pathology E.Q.A. Scheme
Circulation T
This document gives information on individual cases in
circulation T of this scheme. It contains no personal details
of participants.
Cases included:
T 242
T 243
T 244
T 245
T 246
T 247
End
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document are selected by the Organiser in an attempt to
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: T
Case number: 242
....
Number of responses:83 . Date of analysis: 31 DEC 05
Clinical:
38 year old female. Increased cholesterol, overweight, nephrotic range
proteinuria. Congo Red negative. ICC - fine granular IgG and C3 on GBM;
IgM and IgA negative.
Specimen:
H&E, Meth Ag, Photos of EM *2
Macro:
For education and interest only
Diagnostic categories: Score:
1 Membranous Gn 1.06
2 Memb. Gn with 'structured' deposits 0.52
3 Fibrillary Gn, membranous pattern 1.27
4 Fibrillary Gn 4.46
5 Immunotactoid Gn 1.27
6 Amyloid 0.16
7 Membranous AND amyloid 0.48
8 Non-amyloid structured deposits 0.60
9 Membranous amyloid 0.12
10 Light chain nephropathy 0.06
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 4 with 4.46
Secondary diagnoses and comments (if any):
EM of mesangium*4. Scale / Fibril size*10. Repeat Congo red*5. Diabetes?*1.
Exclude plasma cell monoclonality*4. Exclude cryo.*1. SLE serology*2.
Complement levels?*1. Collagen III immunostaining*1.
Original report and further information (if any):
Circulation: T
Case number: 243
....
Number of responses:83 . Date of analysis: 31 DEC 05
Clinical:
Unexplained rapid deterioration in renal function. Mild proteinuria. ?
RPGN. ?Myeloma. ?Infiltrative process. Staining for AAFBs was negative.
IF negative and EM showed no specific glomerular abnormality.
Specimen:
H&E
Diagnostic categories: Score:
1 Granumomatous interstitial nephritis ?sarcoid 1.55
2 Sarcoid 0.00
3 Granulomatous interstitial nephritis, differential given5.54
4 Granulomatous interstitial nephritis NOS 2.65
5 Interstitial nephritis 0.00
6 Granulomatous nephritis, ?TB 0.13
7 Granulomatous nephritis ?drug reaction 0.12
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 3 with 5.54
Secondary diagnoses and comments (if any):
Age, sex?*3. Ethnic origin?*1. More clinical info.*5. Stains for other
organisms/exclude infection*12. PCR for mycobacteria*1. ?drugs*5. Serum
ACE*5. ANCA*7. CXR*5. Serum Ca*1. Exclude myeloma*3.
Original report and further information (if any):
Granulomatous interstitial nephritis. No evidence of TB or drugs. ACE
raised at time of biopsy; interpreted clinically as 'renal sarcoid' but no
extra-renal sarcoid. ACE then normalised. Treated with prednisolone;
function returned to normal and remained so.
Circulation: T
Case number: 244
....
Number of responses:83 . Date of analysis: 31 DEC 05
Clinical:
Female, 23 y.o. Mild proteinuria and haematuria. Immunoperoxidase staining
showed mesangial IgM+ but no glomerular localisation of IgA, IgG, C1q, C3 or
C4.
Specimen:
H&E, EM x 5
Diagnostic categories: Score:
1 Hereditary nephropathy, Alport type 6.90
2 Hereditary nephropathy NOS 0.36
3 IgM nephropathy 0.60
4 FSGS 1.17
5 Thin membrane nephropathy 0.36
6 Hereditary nephropathy - Nail patella syndrome? 0.12
7 Minimal change 0.24
8 Heterozygous Fabry's disease 0.12
10 No diagnosis offered 0.12
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 6.90
Secondary diagnoses and comments (if any):
Autosomal type Alport*5. EM prints too pale *6. Silver stain*1. Lipid
stain*1. Family history?*21. Clinical / extra-renal manifestations?*6.
Type IV col. alpha chain immuno*11. Confirmation by genetics*3. Exclude
diabetes*1.
Original report and further information (if any):
Circulation: T
Case number: 245
....
Number of responses:83 . Date of analysis: 31 DEC 05
Clinical:
59 y.o. Male. Rapidly progressive acute renal failure. Creatinine 540
umol. Nephrotic with ascites, peripheral oedema, hypo-albuminaemia and
proteinuria. On clinical examination he had a purpuric rash on the buttocks
and feet. Auto-antibody screen, ANCA and anti GBM results not available.
Specimen:
H&E, PAS, Meth Ag. Photos IgA
Diagnostic categories: Score:
1 HSP / IgA nephropathy 9.47
2 HIV nephropathy 0.12
3 Lupus 0.07
4 Cryoglobylinaemia 0.02
5 Acute proliferative glomerulonephritis 0.22
6 Collapsing glomerulopathy 0.03
7 Post-infectious Gn 0.06
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 9.47
Secondary diagnoses and comments (if any):
EM*13. Rest of IF?*14. ATN too*7. Also thrombotic microangiopathy*1. Also
interstitial nephritis*1. Lupus serology*4. IgA nephr. in HIV infection?*1.
ASOT*1. Not suitable for EQA*1.
Original report and further information (if any):
Henoch Schonlein purpura. No follow-up info.
Circulation: T
Case number: 246
....
Number of responses:83 . Date of analysis: 31 DEC 05
Clinical:
Male, 15 y.o. Presented with nephrotic syndrome two weeks previously.
Rising creatinine. Positive ANA and decreased complement lelves. ?Lupus.
There is strong staining for all immunoreactants throughout loops and
mesangium.
Specimen:
H&E, MAg, Photos of EM x 2 and IF
Diagnostic categories: Score:
1 Lupus class IV (G, A) 6.12
2 Lupus class IV (A) 0.72
3 Lupus nephritis NOS 0.60
4 Lupus IV NOS 2.23
5 Post-infective Gn 0.01
6 MPGN / MCGN 0.07
7 MPGN pattern, could be lupus 0.12
8 Lupus IV (G, A/C) 0.12
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 6.12
Secondary diagnoses and comments (if any):
Lupus serology?*6. EM*1. Clinical evidence of lupus?*1. Antiphospholipid
Abs?*1. Exclude cryo.*2. HBV?*1. Inadequate info, ?suitable for EQA*1.
Original report and further information (if any):
Lupus nephritis, WHO class IV-G
Circulation: T
Case number: 247
....
Number of responses:82 . Date of analysis: 31 DEC 05
Clinical:
47 year old female. Recent S.A.H. clipping and post-op staph sepsis.
Developed nephrotic syndrome with poor urine output despite diuretics. All
immunology negative.
Specimen:
H&E
Diagnostic categories: Score:
1 Proliferative endocap./post-infective Gn 8.73
2 Mesangiocapillary Gn post infection 0.17
3 Diffuse prolif Gn ? cause 0.49
4 Endocapillary Gn AND interstitial nephritis 0.12
5 Pauci-immune crescentic Gn 0.24
6 Mesangiocapillary glomerulonephritis 0.12
10 No diagnosis offered 0.12
Asterisks (if any) indicate dangerous diagnoses.
Highest scoring diagnosis was 1 with 8.73
Secondary diagnoses and comments (if any):
IF*21. Does 'immunology negative' mean serology or IF?*10. Why is IF
negative?*5. EM*25. Silver stain *12. PAS*1. Trichrome*1. Adequate for
EQA with only H&E?*5. ASOT*2. ANCA*1. Hypertension too*1. Interstitial
nephritis too?drugs*2. Acute pyelo too?*1. Serum C3?*1.
Original report and further information (if any):
Acute proliferative glomerulonephritis, in keeping with post-infectious
glomerulonephritis
Links to cases in this document:
Top
T 242
T 243
T 244
T 245
T 246
T 247
Last updated: 31 DEC 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
