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UK National Renal Pathology EQA Scheme
 
Circulation V
 
Prof. Ian Roberts
V1
Female, 44 yo. SLE (cutaneous vasculitis, ds-DNA positive; anti-Ro, Sm, chromatin, RNP and ANA positive, low complements, inflammatory arthritis). Recent flare of rash and joint pain. UPCR 112, eGFR 53.
 
IF positive in glomeruli for IgG, IgA, IgM, C3, C1q, and lambda, ++ diffuse global granular peripheral and mesangial. Kappa +/-
 
H&E, PAS, silver and 3 EM images provided.  
H&E
PAS
Silver
em1
em2
em3
Diagnosis & discussion [0]
V2
Male, 59 yo. Recent diagnosis of myeloma on treatment. K:L = 14.02. Recent diagnosis of HTN. Cr 200-300.
 
IF: IgA, IgG, C3 and C1q negative. 
 
H&E, silver and Congo red; IF for Kappa and Lambda and 3 EM images provided.
H&E
Silver
Congo Red
IF kappa
IF lambda
em1 x7000
em2 x2500
em3 x7000
Diagnosis & discussion [0]
V3
Female, 71 yo. Remote history of retinal vasculitis, little else in the way of PMH and presents with very non-specific symptoms, principally fatigue over the last 3 weeks. She has AKI, modestly elevated inflammatory markers with urinalysis showing blood + protein +. ? vasculitis.
 
IF: negative for IgG, IgM, C3 and C1q. 
 
H&E provided. 
H&E
Diagnosis & discussion [0]
V4
Male, 73 yo. PCR 4g. Increased lambda and kappa light chains. Breathless, awaiting cardiology review. 
 
IF: IgG and IgA are negative. IgM and C3 positive in sclerosed areas. 
 
H&E, PAS, silver, Congo red and 1 EM image provided.
H&E
PAS
Silver
Congo Red
em1
Diagnosis & discussion [0]
V5
Female, 25 yo. Acute presentation with shortness of breath, decreased EF, heart failure. ? viral myocarditis. Low C3. Cr increased, eGFR 50. ? lupus nephritis ? post infectious GN
 
IH: Immunoglobulins negative. C3 provided. 
 
H&E, PAS, silver, C3 IHC and 2 EM images provided.  
H&E
PAS
Silver
C3 IH
C3 IH
em1
em2
Diagnosis & discussion [0]
V6
Female, 35 yo. AKI ? cause. ? post inflammatory GN ? interstitial nephritis
Haemoproteinuria. History of malaria treated in Nigeria 1/52 ago. Return from Nigeria on 10/4/18. ACR 1618.6. Albumin 22. Cr 269.
 
IF: IgG, IgA, C3d negative; C1q membranous and mesangial + ? significant
 
H&E and PAS provided. 
H&E
PAS
Diagnosis & discussion [0]
V7
Female, 74 yo. Nephrotic range proteinuria - Nephrotic syndrome + AKI - creatinine 120. PCR 1933. Cause. H/O Hypertension.
Additional info: ++ blood and +++ protein on urine dip. Low C3, C4 and raised ds-DNA titres.
 
IH: IgG, IgM, IgA, C3 and C1q all show granular capillary wall positivity. C1q provided as representative.  
 
H&E, PAS, C1q IH and 3 EM images provided.  
H&E
Silver
C1q IH
em1 x1700
em2 x6000
em3 x20500
Diagnosis & discussion [0]
V8
Female, 81 yo. T2DM for 15 years but no retinopathy. AF on apixaban. HTN on atenolol and furosemide. Cr 180. Unwell; GP found Cr to be now 440. Recent diarrhoea. Dip trace blood and trace protein. Acute screen unhelpful - mild eosinophilia since last year.
 
IF: Negative for IgA, IgG, IgM, C3, C1q, kappa and lambda. 
 
EM: not performed. 
 
H&E provided.  
H&E
Diagnosis & discussion [0]
V9
Male, 54 yo. Normal sized kidneys and 3.5g proteinuria in 24h. Negative autoimmune screen. Cr 157. Hypertension. ? Chronic GN
 
IF: Weak segmental positivity for C3. Rest (IgG, IgA, IgM, C1q, kappa, lambda) negative.
 
H&E, Trichrome, Silver, Congo red and 3 EM images provided. 
H&E
Trichrome
Silver
Congo red
em1
em2
em3
Diagnosis & discussion [0]
V10
Male, 64 yo. CLL diagnosed 2 years ago. FDC chemotherapy for 5 months, completed 8 months ago, with partial remission. Presented with Cr > 1000 from 204. K:L 1.25. Dip 2+ blood 2+ protein. Albumin 39. 
 
IH: IgA, IgG and C3 are negative.
 
H&E provided. 
H&E
Diagnosis & discussion [0]
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