Renal pathology

Renal pathology US Medical PG Question 1: A 22-year-old man comes to the physician because of a 2-week history of cough and decreased urination. The cough was initially nonproductive, but in the last few days he has coughed up small amounts of blood-tinged sputum with clots. He has not had any fevers, chills, or weight loss. He has smoked one pack of cigarettes daily for 5 years. Pulse is 115/min and blood pressure is 125/66 mm Hg. Physical examination shows dried blood around the lips. Serum studies show a creatinine of 2.9 mg/dL. Results of a serum antineutrophil cytoplasm antibody test are negative. A biopsy specimen of the kidney is most likely to show which of the following light microscopy findings?

• A. Thinning of the basement membrane
• B. Fibrin crescents in Bowman space (Correct Answer)
• C. Expansion of the mesangial matrix
• D. Enlarged and hypercellular glomeruli
• E. Neutrophilic infiltration of the capillaries

Renal pathology Explanation: ***Fibrin crescents in Bowman space*** - The patient's presentation with **hemoptysis** (coughing up blood) and **acute kidney injury** (decreased urination, elevated creatinine 2.9 mg/dL) suggests a **pulmonary-renal syndrome**. The **negative ANCA** is a key distinguishing feature pointing towards **Goodpasture syndrome (anti-GBM disease)**. - Goodpasture syndrome is characterized by **rapidly progressive glomerulonephritis**, classically showing **crescent formation** (fibrin and proliferating parietal epithelial cells) in Bowman's space on light microscopy. The linear IgG deposition on basement membrane would be seen on immunofluorescence. *Thinning of the basement membrane* - This finding is characteristic of **Alport syndrome**, a hereditary nephritis presenting with hematuria, sensorineural hearing loss, and ocular abnormalities. - The patient's acute presentation with hemoptysis and rapidly progressive renal failure is inconsistent with Alport syndrome, which typically has a more chronic course. *Expansion of the mesangial matrix* - **Mesangial matrix expansion** is seen in **diabetic nephropathy** and **IgA nephropathy**. - While IgA nephropathy can cause hematuria and occasionally upper respiratory symptoms, it typically does not present with significant hemoptysis and the acute, severe renal failure seen here. *Enlarged and hypercellular glomeruli* - **Glomerular enlargement and hypercellularity** are features of **post-streptococcal glomerulonephritis** (diffuse proliferative glomerulonephritis). - The absence of preceding infection history and the prominent hemoptysis with negative ANCA make this less likely than Goodpasture syndrome. *Neutrophilic infiltration of the capillaries* - **Neutrophilic infiltration** (endocapillary proliferation) is characteristic of **acute post-infectious glomerulonephritis**. - The pulmonary-renal syndrome presentation without clear evidence of recent infection and negative ANCA makes this diagnosis unlikely.

Renal pathology US Medical PG Question 2: On cardiology service rounds, your team sees a patient admitted with an acute congestive heart failure exacerbation. In congestive heart failure, decreased cardiac function leads to decreased renal perfusion, which eventually leads to excess volume retention. To test your knowledge of physiology, your attending asks you which segment of the nephron is responsible for the majority of water absorption. Which of the following is a correct pairing of the segment of the nephron that reabsorbs the majority of all filtered water with the means by which that segment absorbs water?

• A. Distal convoluted tubule via passive diffusion following ion reabsorption
• B. Distal convoluted tubule via aquaporin channels
• C. Thick ascending loop of Henle via passive diffusion following ion reabsorption
• D. Proximal convoluted tubule via passive diffusion following ion reabsorption (Correct Answer)
• E. Collecting duct via aquaporin channels

Renal pathology Explanation: ***Proximal convoluted tubule via passive diffusion following ion reabsorption*** - The **proximal convoluted tubule (PCT)** is responsible for reabsorbing approximately **65-70% of filtered water**, making it the primary site of water reabsorption in the nephron. - This water reabsorption primarily occurs **passively**, following the active reabsorption of solutes (especially **sodium ions**), which creates an osmotic gradient. *Distal convoluted tubule via passive diffusion following ion reabsorption* - The **distal convoluted tubule (DCT)** reabsorbs a much smaller percentage of filtered water (around 5-10%) and its water reabsorption is largely **regulated by ADH**, not primarily simple passive diffusion following bulk ion reabsorption. - While some passive water movement occurs, it is not the main mechanism or location for the majority of water reabsorption. *Distal convoluted tubule via aquaporin channels* - While aquaporin channels do play a role in water reabsorption in the DCT, particularly under the influence of **ADH**, the DCT is not the segment responsible for the **majority of all filtered water absorption**. - The bulk of water reabsorption occurs earlier in the nephron, independently of ADH for the most part. *Thick ascending loop of Henle via passive diffusion following ion reabsorption* - The **thick ascending loop of Henle** is primarily involved in reabsorbing ions like Na+, K+, and Cl- but is largely **impermeable to water**. - Its impermeability to water is crucial for creating the **osmotic gradient** in the renal medulla, which is necessary for later water reabsorption. *Collecting duct via aquaporin channels* - The **collecting duct** is critically important for **regulated water reabsorption** via **aquaporin-2 channels** under the influence of **ADH**, allowing for fine-tuning of urine concentration. - However, it reabsorbs only a variable portion (typically 5-19%) of the remaining filtered water, not the **majority of all filtered water**.

Renal pathology US Medical PG Question 3: A 42-year-old man presents to his primary care provider complaining of foamy urine for the last 2 weeks. He has also begun to notice swelling in his hands and feet, and he says that his shoes have not been fitting normally. On exam, the patient has a temperature of 98.8°F (37.1°C), blood pressure is 132/84 mmHg, pulse is 64/min, and respirations are 12/min. The patient has 2+ pitting edema bilaterally up to his shins. A 24-hour urine study is found to contain 9.0 g of protein. The patient is referred to a specialist and undergoes a renal biopsy. On light microscopy, the glomeruli demonstrate basement membrane thickening. On electron microscopy, subepithelial deposits are seen. Which of the following is a characteristic of this patient’s disease?

• A. X-linked condition
• B. Antibodies to alveolar basement membrane
• C. Loss of podocyte foot processes
• D. Antibodies to phospholipase A2 receptor (Correct Answer)
• E. IgA immune complex deposition

Renal pathology Explanation: ***Antibodies to phospholipase A2 receptor*** - The patient's presentation with **foamy urine**, **edema**, and **9.0 g of protein** in a 24-hour urine study indicates **nephrotic syndrome**. Renal biopsy findings of **glomerular basement membrane thickening** on light microscopy and **subepithelial deposits** on electron microscopy are characteristic of **membranous nephropathy**. - Approximately 70-80% of primary membranous nephropathy cases are associated with **autoantibodies to the M-type phospholipase A2 receptor (PLA2R)**, a protein expressed on podocytes. *X-linked condition* - This description is characteristic of **Alport syndrome**, a genetic disorder leading to progressive kidney disease, hearing loss, and eye abnormalities. - Alport syndrome presents with **hematuria** rather than significant proteinuria, and biopsy would show **laminar splitting of the glomerular basement membrane**. *Antibodies to alveolar basement membrane* - This describes **Goodpasture syndrome**, which is characterized by the presence of anti-glomerular basement membrane (anti-GBM) antibodies that target both the kidney and the lung. - Patients typically present with rapidly progressive glomerulonephritis and pulmonary hemorrhage, and biopsy would show **linear IgG deposition** along the glomerular basement membrane on immunofluorescence. *Loss of podocyte foot processes* - This is a characteristic finding in **minimal change disease** and **focal segmental glomerulosclerosis (FSGS)**, two other causes of nephrotic syndrome. - Minimal change disease typically shows normal glomeruli on light microscopy, while FSGS shows segmental sclerosis. Neither shows subepithelial deposits. *IgA immune complex deposition* - This is the hallmark of **IgA nephropathy (Berger's disease)** or **Henoch-Schönlein purpura** in children. - Patients typically present with **hematuria**, often macroscopic, following an upper respiratory or gastrointestinal infection. Biopsy would show IgA deposits in the mesangium, not subepithelial deposits.

Renal pathology US Medical PG Question 4: A 53-year-old woman presents to her physician for evaluation of sudden onset respiratory distress for the past few hours. The past medical history includes a myocardial infarction 2 years ago. The vital signs include a blood pressure 70/40 mm Hg, pulse 92/min, respiratory rate 28/min, and SpO2 92% on room air. The physical examination reveals bilateral basal crepitations on auscultation. The echocardiogram reveals an ejection fraction of 34%. She is admitted to the medical floor and started on furosemide. The urine output in 24 hours is 400 mL. The blood urea nitrogen is 45 mg/dL and the serum creatinine is 1.85 mg/dL. The fractional excretion of sodium is 2.4%. Urinalysis revealed muddy brown granular casts. Which of the following is the most likely cause of the abnormal urinalysis?

• A. Acute interstitial nephritis
• B. Acute tubular necrosis (Correct Answer)
• C. Acute pyelonephritis
• D. Chronic kidney disease
• E. Acute glomerulonephritis

Renal pathology Explanation: ***Acute tubular necrosis*** - The presence of **muddy brown granular casts** on urinalysis is pathognomonic for **acute tubular necrosis (ATN)**, indicating damage to the renal tubules. - The patient's history of **cardiogenic shock** (low BP 70/40 mm Hg, respiratory distress, low SpO2, low ejection fraction of 34%) led to **renal hypoperfusion** and ischemic tubular injury. - The **fractional excretion of sodium (FENa) of 2.4%** (>2%) is characteristic of **intrinsic renal injury** (ATN), as damaged tubules cannot effectively reabsorb sodium. - **Oliguria** (400 mL/24 hours), elevated **BUN (45 mg/dL)** and **creatinine (1.85 mg/dL)** further support acute kidney injury from ATN. *Acute interstitial nephritis* - This condition is typically associated with **drug hypersensitivity** (e.g., NSAIDs, antibiotics, PPIs) or **infections** and is characterized by inflammatory infiltrate in the renal interstitium. - Urinalysis typically shows **white blood cell casts** and **eosinophiluria**, not muddy brown granular casts. *Acute pyelonephritis* - This is an **infection of the kidney** parenchyma, usually caused by bacterial ascension from the urinary tract. - Symptoms often include **fever, flank pain, dysuria**, and urinalysis reveals **leukocyturia** (white blood cells) and **bacterial casts**, not muddy brown granular casts. *Chronic kidney disease* - While the patient has elevated creatinine and BUN, **chronic kidney disease (CKD)** develops over months to years and is characterized by persistent kidney damage or decreased function. - Urinalysis in CKD often shows **broad waxy casts** and typically does not present with such **acute, sudden onset** of severe renal dysfunction with muddy brown granular casts. *Acute glomerulonephritis* - This condition involves inflammation of the glomeruli and typically presents with **hematuria, proteinuria, and red blood cell casts** (dysmorphic RBCs). - The patient's clinical picture, including the absence of significant hematuria and the presence of **muddy brown granular casts**, does not fit acute glomerulonephritis.

Renal pathology US Medical PG Question 5: A 6-year-old boy is brought to the physician because of increasing swelling around his eyes for the past 3 days. During this period, he has had frothy light yellow urine. He had a sore throat 12 days ago. He appears tired. His temperature is 37°C (98.6°F), pulse is 90/min, and blood pressure is 105/65 mm Hg. Examination shows periorbital edema and pitting edema of the lower extremities. Cardiopulmonary examination shows no abnormalities. Which of the following findings on urinalysis is most likely associated with this patient's condition?

• A. WBC casts
• B. Fatty casts (Correct Answer)
• C. Hyaline casts
• D. RBC casts
• E. Muddy brown casts

Renal pathology Explanation: ***Fatty casts*** - The patient's symptoms of **periorbital edema**, **pitting edema of lower extremities**, and **frothy urine** are classic for **nephrotic syndrome**, characterized by massive **proteinuria** (>3.5 g/day), **hypoalbuminemia**, **hyperlipidemia**, and **edema**. - **Fatty casts** (also called **oval fat bodies** when in tubular cells) are **pathognomonic for nephrotic syndrome** and result from hyperlipidemia and lipiduria associated with severe proteinuria. - In a **6-year-old child**, the most common cause of nephrotic syndrome is **minimal change disease**. *WBC casts* - **WBC casts** indicate **renal parenchymal inflammation** or **infection**, such as **pyelonephritis**, **acute interstitial nephritis**, or **tubulointerstitial disease**. - These are not characteristic findings in **nephrotic syndrome**, which primarily affects the **glomerular filtration barrier** leading to protein loss rather than inflammatory cell infiltration. *Hyaline casts* - **Hyaline casts** are composed of **Tamm-Horsfall protein** and can be found in **normal urine**, especially with **dehydration**, **exercise**, or **concentrated urine**. - They are **non-specific** and do not indicate significant kidney pathology or nephrotic syndrome. *RBC casts* - **RBC casts** are characteristic of **glomerulonephritis** and **nephritic syndrome** (such as **post-streptococcal glomerulonephritis**), where patients present with **hematuria**, **hypertension**, **mild edema**, and **oliguria**. - While this patient had a **sore throat 12 days ago** (typical timing for post-streptococcal disease), his clinical presentation is clearly **nephrotic** (massive edema, frothy urine, normal blood pressure) rather than **nephritic**, making RBC casts unlikely. - The **frothy urine** indicates significant **proteinuria**, not hematuria. *Muddy brown casts* - **Muddy brown casts** (granular casts with epithelial cell debris) are highly suggestive of **acute tubular necrosis (ATN)**, typically resulting from **ischemic** or **nephrotoxic injury**. - This patient's presentation with **gradual onset edema** and **frothy urine** points to a **glomerular disorder** (nephrotic syndrome), not **acute tubular injury**.

Renal pathology US Medical PG Question 6: A 22-year-old man comes to the emergency department because of several episodes of blood in his urine and decreased urine output for 5 days. His blood pressure is 158/94 mm Hg. Examination shows bilateral lower extremity edema. Urinalysis shows 3+ protein and red blood cell casts. Mass spectrometry analysis of the urinary protein detects albumin, transferrin, and IgG. Which of the following best describes this type of proteinuria?

• A. Tubular
• B. Selective glomerular
• C. Nonselective glomerular (Correct Answer)
• D. Postrenal
• E. Overflow

Renal pathology Explanation: ***Nonselective glomerular*** - The presence of **albumin**, **transferrin**, and **IgG** indicates a loss of molecular control by the glomerulus, allowing both small and larger proteins to pass. - This pattern, particularly with significant proteinuria (3+ protein) and **red blood cell casts**, is characteristic of a severe **glomerular injury** leading to nonselective filtration. *Tubular* - **Tubular proteinuria** results from impaired reabsorption of low-molecular-weight proteins by the renal tubules, typically due to **tubulointerstitial damage**. - It would primarily involve smaller proteins like **beta-2 microglobulin** or **retinol-binding protein**, not significant amounts of albumin and IgG. *Selective glomerular* - **Selective glomerular proteinuria** involves the loss of smaller proteins, primarily **albumin**, due to damage to the glomerular charge barrier, while larger proteins like IgG are retained. - The detection of **IgG** in the urine indicates a loss of both charge and size selectivity, ruling out selective proteinuria. *Postrenal* - **Postrenal proteinuria** is due to inflammation or bleeding in the urinary tract below the kidneys, such as the ureters, bladder, or urethra. - It is typically associated with conditions like **urinary tract infections** or **stones** and would not cause the significant systemic symptoms (hypertension, edema) or protein profile seen here. *Overflow* - **Overflow proteinuria** occurs when there is an overproduction of low-molecular-weight proteins (e.g., **Bence Jones proteins** in multiple myeloma) that overwhelm the reabsorptive capacity of the tubules. - This patient presents with **glomerular injury** features (red blood cell casts, hypertension, edema) and the presence of albumin and IgG, not an overproduction of single-type low-molecular-weight proteins.

Renal pathology US Medical PG Question 7: A 26-year-old woman presents with blood in her urine for the past 2 days. She says she has had increasing urinary frequency at night for the past several days and recently noticed a reddish tinge in her urine. She is also concerned that her feet are beginning to swell, and she has been feeling increasingly fatigued for the past week. She gives no history of joint pains, rashes, or skin changes. Past medical history is relevant for an occasional bluish discoloration of her fingers during exposure to cold. Her vital signs are a pulse of 80/min, a respiratory rate of 14/min, and blood pressure of 140/88 mm Hg. On physical examination, the patient has 1+ pitting edema of her feet bilaterally. Remainder of examination is unremarkable. Laboratory findings are significant for the following: Serum glucose (fasting) 88 mg/dL Sodium 143 mEq/L Potassium 3.7 mEq/L Chloride 102 mEq/L Serum creatinine 1.7 mg/dL Blood urea nitrogen 32 mg/dL Cholesterol, total 180 mg/dL HDL-cholesterol 43 mg/dL LDL-cholesterol 75 mg/dL Triglycerides 135 mg/dL Hemoglobin (Hb%) 12.5 g/dL Mean corpuscular volume (MCV) 80 fL Reticulocyte count 1% Erythrocyte count 5.1 million/mm3 Thyroid stimulating hormone 4.5 μU/mL Urinalysis: Glucose negative Protein +++ Ketones negative Nitrites negative RBCs negative Casts +++ A renal biopsy is performed which reveals findings consistent with lupus nephritis. Which of the following is the next best step in treatment of this patient?

• A. Cyclophosphamide
• B. Mycophenolic acid (Correct Answer)
• C. Corticosteroids
• D. Cyclosporine
• E. Azathioprine

Renal pathology Explanation: ***Mycophenolic acid*** - **Mycophenolic acid** (mycophenolate mofetil or mycophenolate sodium) is the **first-line induction therapy** for **lupus nephritis Class III, IV, and V** according to current **KDIGO, ACR, and EULAR guidelines** (2012-2023). - This patient has biopsy-proven lupus nephritis with active disease (proteinuria +++, casts +++, elevated creatinine, hypertension, edema). - Mycophenolate is typically given **in combination with high-dose corticosteroids** for induction therapy, followed by maintenance therapy. - It has **superior efficacy** and **lower toxicity** (particularly reduced gonadal toxicity and malignancy risk) compared to cyclophosphamide. - Given as **2-3 g/day** for induction over 6 months, then reduced for maintenance. *Corticosteroids* - While **high-dose corticosteroids** are essential in lupus nephritis treatment, they are **never used as monotherapy** for proliferative or membranous lupus nephritis. - Steroids alone are insufficient to control active renal inflammation and prevent progression to end-stage renal disease. - They must be combined with an immunosuppressant like **mycophenolate** or **cyclophosphamide** for induction therapy. *Cyclophosphamide* - **Cyclophosphamide** remains an alternative induction agent for severe lupus nephritis, particularly Class III or IV. - However, it has been largely replaced by **mycophenolate** as first-line therapy due to mycophenolate's better side effect profile. - Cyclophosphamide is now reserved for cases with **severe renal dysfunction**, **rapidly progressive disease**, or **failure of mycophenolate therapy**. - Significant toxicities include **gonadal failure** (infertility concerns in young women), **hemorrhagic cystitis**, and increased **malignancy risk**. *Cyclosporine* - **Cyclosporine** is a calcineurin inhibitor occasionally used for **membranous lupus nephritis (Class V)** or as second-line therapy. - It is **not recommended for proliferative nephritis** (Class III or IV) due to risk of **nephrotoxicity** and inferior efficacy compared to mycophenolate or cyclophosphamide. - May be considered in special circumstances such as pregnancy or contraindications to other agents. *Azathioprine* - **Azathioprine** is primarily used for **maintenance therapy** after successful induction with mycophenolate or cyclophosphamide. - It has a **slower onset of action** and is **less potent** than mycophenolate for treating active lupus nephritis. - Not appropriate as initial induction therapy for moderate-to-severe lupus nephritis with active renal inflammation.

Renal pathology US Medical PG Question 8: A 4-year-old girl is brought to the physician because of increasing swelling around her eyes and over both her feet for the past 4 days. During this period, she has had frothy light yellow urine. Her vital signs are within normal limits. Physical examination shows periorbital edema and 2+ pitting edema of the lower legs and ankles. A urinalysis of this patient is most likely to show which of the following findings?

• A. Fatty casts (Correct Answer)
• B. Epithelial casts
• C. WBC casts
• D. Waxy casts
• E. Muddy brown casts

Renal pathology Explanation: ***Fatty casts*** - The presence of **periorbital edema**, **pitting edema** of the lower legs and ankles, and **frothy urine** in a child is highly suggestive of **nephrotic syndrome**. - **Fatty casts** are formed when lipid-laden renal tubular epithelial cells (oval fat bodies) aggregate and are expelled into the urine, and are characteristically associated with **nephrotic syndrome** due to massive proteinuria and lipiduria. - Among the cast types listed, fatty casts are the most specific finding for nephrotic syndrome. *Epithelial casts* - **Epithelial cell casts** indicate **acute tubular necrosis (ATN)** or other conditions involving damage to the renal tubular epithelium. - While ATN can cause edema, the clinical presentation here (frothy urine, periorbital edema, absence of oliguria or acute kidney injury) is more classic for nephrotic syndrome. *WBC casts* - **White blood cell (WBC) casts** are indicative of **renal parenchymal inflammation** or **infection**, such as pyelonephritis or interstitial nephritis. - The patient's symptoms do not suggest infection, and there is no mention of fever, dysuria, or flank pain. *Waxy casts* - **Waxy casts** typically indicate **chronic kidney disease** and advanced renal failure, representing severe urinary stasis and dilated, damaged tubules. - The acute onset of symptoms (4 days) in a 4-year-old child makes chronic kidney disease less likely as the primary diagnosis. *Muddy brown casts* - **Muddy brown casts** are pathognomonic for **acute tubular necrosis (ATN)**, often seen in cases of ischemia or nephrotoxic injury. - While ATN is a severe renal injury, the patient's presentation with frothy urine and prominent edema without signs of acute kidney injury points more specifically to nephrotic syndrome.

Renal pathology US Medical PG Question 9: A 72-year-old woman with a medical history significant for chronic kidney disease stage 4, hypertension, and type 2 diabetes mellitus, presents to the office for a scheduled visit. During her last visit, the physician started discussing with her the possibility of starting her on dialysis for her chronic kidney disease. The patient has no complaints about her health and enjoys spending time with her family. At presentation, she is afebrile; the blood pressure is 139/89 mm Hg and the heart rate is 80/min. On physical examination, her pulses are bounding, the complexion is pale, she has a grade ⅙ holosystolic murmur, breath sounds remain clear, and 2+ pedal edema to the knee. The measurement of which of the following laboratory values is most appropriate to screen for renal osteodystrophy in this patient?

• A. Erythrocyte sedimentation rate
• B. Serum vitamin B-12 level
• C. Serum C-reactive protein level
• D. Serum thyroid-stimulating hormone level
• E. Serum intact parathyroid hormone level (Correct Answer)

Renal pathology Explanation: ***Serum intact parathyroid hormone level*** - **Renal osteodystrophy**, a common complication of **chronic kidney disease (CKD)** stage 4 and 5, is primarily caused by secondary hyperparathyroidism. - **Intact parathyroid hormone (iPTH)** is critical in diagnosing and monitoring this condition, as elevated levels indicate impaired mineral and bone metabolism due to failing kidneys. *Erythrocyte sedimentation rate* - **Erythrocyte sedimentation rate (ESR)** is a general marker of inflammation and is not specific for renal osteodystrophy. - While CKD can be associated with inflammation, ESR does not directly assess mineral and bone disorders. *Serum vitamin B-12 level* - **Vitamin B-12** deficiency can cause anemia and neurological symptoms, but it is not directly involved in the pathogenesis or diagnosis of renal osteodystrophy. - This test would be more relevant if the patient presented with symptoms of **pernicious anemia** or neuropathy. *Serum C-reactive protein level* - **C-reactive protein (CRP)**, like ESR, is a general **inflammatory marker** and does not provide specific information about bone health or mineral metabolism in CKD. - High CRP levels might indicate infection or systemic inflammation but are not used to screen for renal osteodystrophy. *Serum thyroid-stimulating hormone level* - **Thyroid-stimulating hormone (TSH)** assesses **thyroid function**, which is distinct from renal osteodystrophy. - Thyroid disorders can impact bone health, but TSH is not the primary screening test for bone disease related to CKD.

Renal pathology US Medical PG Question 10: A 28-year-old male presents to his primary care physician with complaints of intermittent abdominal pain and alternating bouts of constipation and diarrhea. His medical chart is not significant for any past medical problems or prior surgeries. He is not prescribed any current medications. Which of the following questions would be the most useful next question in eliciting further history from this patient?

• A. "Does the diarrhea typically precede the constipation, or vice-versa?"
• B. "Is the diarrhea foul-smelling?"
• C. "Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life"
• D. "Are the symptoms worse in the morning or at night?"
• E. "Can you tell me more about the symptoms you have been experiencing?" (Correct Answer)

Renal pathology Explanation: ***Can you tell me more about the symptoms you have been experiencing?*** - This **open-ended question** encourages the patient to provide a **comprehensive narrative** of their symptoms, including details about onset, frequency, duration, alleviating/aggravating factors, and associated symptoms, which is crucial for diagnosis. - In a patient presenting with vague, intermittent symptoms like alternating constipation and diarrhea, allowing them to elaborate freely can reveal important clues that might not be captured by more targeted questions. *Does the diarrhea typically precede the constipation, or vice-versa?* - While knowing the sequence of symptoms can be helpful in understanding the **pattern of bowel dysfunction**, it is a very specific question that might overlook other important aspects of the patient's experience. - It prematurely narrows the focus without first obtaining a broad understanding of the patient's overall symptomatic picture. *Is the diarrhea foul-smelling?* - Foul-smelling diarrhea can indicate **malabsorption** or **bacterial overgrowth**, which are important to consider in some gastrointestinal conditions. - However, this is a **specific symptom inquiry** that should follow a more general exploration of the patient's symptoms, as it may not be relevant if other crucial details are missed. *Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life* - Quantifying pain intensity is useful for assessing the **severity of discomfort** and monitoring changes over time. - However, for a patient with intermittent rather than acute, severe pain, understanding the **character, location, and triggers** of the pain is often more diagnostically valuable than just a numerical rating initially. *Are the symptoms worse in the morning or at night?* - Diurnal variation can be relevant in certain conditions, such as inflammatory bowel diseases where nocturnal symptoms might be more concerning, or functional disorders whose symptoms might be stress-related. - This is another **specific question** that should come after gathering a more complete initial picture of the patient's symptoms to ensure no key information is overlooked.

Renal pathology Flashcard 1 of 8

Question: The nephrotoxicity caused by calcineurin inhibitors can result in histologic findings that include early arteriolar hyalinization and tubular _____

Answer: vacuolization

Renal pathology Flashcard 2 of 8

Question: What bone pathology is associated with chronic renal failure? _____

Answer: Renal osteodystrophy

Renal pathology Flashcard 3 of 8

Question: Focal segmental glomerulosclerosis ultimately progresses to _____

Answer: chronic renal failure

Renal pathology Flashcard 4 of 8

Question: RPGN with a granular immunofluorescence pattern is more commonly due to _____

Answer: poststreptococcal glomerulonephritis

Renal pathology Flashcard 5 of 8

Question: What renal pathology is associated with eosinophils in the urine? _____

Answer: Acute interstitial nephritis

Renal pathology Flashcard 6 of 8

Question: Acute interstitial nephritis may progress to renal _____ necrosis

Answer: papillary

Renal pathology Flashcard 7 of 8

Question: Diffuse proliferative glomerulonephritis is characterized by a _____ pattern on immunofluorescence

Answer: granular

Renal pathology Flashcard 8 of 8

Question: _____ casts are nonspecific and are often seen in concentrated urine samples (can be a normal finding)

Answer: Hyaline