Renal Pathology Practice Questions

Q: A 70-year-old male, a known case of a certain malignancy, presents with elevated erythropoietin levels and a packed cell volume (PCV) of 52%. Which tumor is most likely responsible?

Renal Cell Carcinoma. ### **Explanation** **1. Why Renal Cell Carcinoma (RCC) is Correct:** The clinical presentation of elevated erythropoietin (EPO) and a high packed cell volume (PCV) in the presence of a malignancy points toward a **Paraneoplastic Syndrome**. RCC is the most common cause of **paraneoplastic erythrocytosis** [1], [3]. The tumor cells ectopically produce erythropoietin, which stimulates the bone marrow to increase red blood cell production, leading to secondary polycythemia (erythrocytosis) [3]. **2. Why the Other Options are Incorrect:** * **Medullary Thyroid Carcinoma:** Typically associated with the secretion of Calcitonin, CEA, or ACTH (leading to Cushing syndrome), but not EPO [2]. * **Gastric Carcinoma:** Often presents with iron deficiency anemia due to chronic occult blood loss, rather than erythrocytosis. * **Colorectal Carcinoma:** Similar to gastric cancer, it is a common cause of microcytic hypochromic anemia due to chronic GI bleeding. **3. High-Yield Clinical Pearls for NEET-PG:** * **Differential Diagnosis for Ectopic EPO Production:** Remember the mnemonic **"Potentially Really High Hematocrit"**: * **P**heochromocytoma * **R**enal Cell Carcinoma (Most common) [1] * **H**epatocellular Carcinoma (HCC) * **H**emangioblastoma (Cerebellar) * **U**terine Leiomyoma (Fibroids) * **Stauffer Syndrome:** A unique paraneoplastic syndrome in RCC characterized by reversible hepatic dysfunction (elevated ALP) without liver metastases. * **Classic Triad of RCC:** Hematuria, flank pain, and a palpable abdominal mass (seen in only 10% of cases). * **Investigation of Choice:** Contrast-Enhanced CT (CECT) of the abdomen [1].

Q: A 62-year-old patient from Wales, currently in the US, develops oliguria and peripheral edema over a period of weeks. Urinalysis reveals hematuria and proteinuria, and examination of the urinary sediment shows red cell casts. Renal biopsy demonstrates numerous glomerular crescents. What condition is most suggested by this presentation?

Rapidly progressive glomerulonephritis. **Explanation:** The clinical presentation of **oliguria, hematuria, and red cell casts** indicates an **Acute Nephritic Syndrome**. The rapid progression over weeks and the hallmark finding of **numerous glomerular crescents** on renal biopsy are pathognomonic for **Rapidly Progressive Glomerulonephritis (RPGN)** [1]. 1. **Why RPGN is correct:** RPGN is a clinical syndrome characterized by a rapid decline in GFR (usually >50% within weeks to months). The "crescents" are formed by the proliferation of parietal epithelial cells and the infiltration of monocytes/macrophages into Bowman’s space, triggered by the leakage of fibrin through a ruptured glomerular basement membrane [1], [2]. 2. **Why other options are wrong:** * **Diabetic Nephropathy:** Typically presents with chronic, progressive albuminuria and Kimmelstiel-Wilson nodules on biopsy, not acute oliguria or crescents [1]. * **Hypertensive Nephropathy:** Presents with chronic renal failure and "flea-bitten" kidney (in malignant HTN), but biopsy shows hyaline arteriolosclerosis, not crescents. * **Lupus Nephritis:** While it can cause RPGN (Class IV), the question asks for the condition *most suggested* by the specific histological finding of crescents. RPGN is the overarching diagnosis for this pathological state. **NEET-PG High-Yield Pearls:** * **Crescents:** Must involve >50% of glomeruli to be classified as RPGN. * **Classification of RPGN:** * **Type I:** Anti-GBM disease (e.g., Goodpasture syndrome) – Linear IgG deposits [2]. * **Type II:** Immune-complex mediated (e.g., PSGN, SLE) – Granular deposits [2]. * **Type III:** Pauci-immune (e.g., Wegener’s/GPA) – ANCA associated, no deposits. * **Management:** Often requires urgent pulse steroids and cyclophosphamide/plasmapheresis.

Q: Loss of 'Y' chromosome is associated with which of the following types of renal cell carcinoma (RCC)?

Papillary RCC. **Explanation:** The correct answer is **Papillary Renal Cell Carcinoma (RCC)**. **1. Why Papillary RCC is correct:** Papillary RCC is characterized by specific cytogenetic abnormalities. The most common genetic alterations include **trisomy of chromosomes 7 and 17** and the **loss of the Y chromosome** in males [1]. These changes are particularly characteristic of the sporadic (Type 1) form of the disease [1]. While trisomies are diagnostic hallmarks, the loss of the Y chromosome is a highly specific high-yield finding associated with this subtype. **2. Why the other options are incorrect:** * **Clear cell RCC:** This is the most common subtype (70-80%) and is primarily associated with the **deletion of the 3p chromosome** (containing the VHL gene) [1]. It is not typically associated with Y chromosome loss. * **Chromophobe RCC:** This subtype is characterized by **extreme hypodiploidy**, involving the concurrent loss of multiple entire chromosomes (1, 2, 6, 10, 13, 17, and 21) [1]. It has a better prognosis than clear cell RCC [1]. * **Collecting duct RCC:** This is a rare, highly aggressive tumor arising from the medulla. Its genetics are complex and distinct from the common cortical RCCs, often involving losses of 1q, 6p, 8p, and 21q. **3. High-Yield Facts for NEET-PG:** * **Clear Cell RCC:** Deletion 3p (VHL gene); most common; associated with Von Hippel-Lindau syndrome [1]. * **Papillary RCC:** Trisomy 7, 17 and Loss of Y; originates from proximal convoluted tubules [1]. * **Chromophobe RCC:** Multiple chromosome losses; shows "halo" around nuclei (koilocytic-like) and stains positive with **Hale’s Colloidal Iron** [1]. * **Translocation RCC:** Associated with **TFE3 gene** translocations; typically seen in younger patients [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 958-961.

Q: An 8-year-old child presents with severe abdominal pain and palpable purpura. There is a history of recent, resolved diarrhea. What is the expected pathological finding in the kidney?

Mesangial deposits of IgA on electron microscopy. ### Explanation The clinical presentation of **palpable purpura** (typically on the buttocks and lower extremities) and **abdominal pain** (colic) in a child is classic for **Henoch-Schönlein Purpura (HSP)**, also known as IgA Vasculitis. HSP is a small-vessel vasculitis that frequently follows an upper respiratory or gastrointestinal infection. **1. Why the Correct Answer is Right:** HSP is pathologically identical to **IgA Nephropathy (Berger’s disease)**, though it presents with systemic involvement. The hallmark of renal involvement in HSP is the deposition of **IgA-dominant immune complexes** within the **mesangium** of the glomeruli. On electron microscopy, these appear as electron-dense deposits in the mesangial region. Immunofluorescence would similarly show granular IgA and C3 deposits. **2. Why the Incorrect Options are Wrong:** * **Option A:** Podocyte effacement is the hallmark of **Minimal Change Disease**, which presents with nephrotic syndrome (massive edema, proteinuria) rather than purpura. * **Option B:** Electron-dense deposits *within* the GBM (ribbon-like) are characteristic of **Type II Membranoproliferative Glomerulonephritis (Dense Deposit Disease)**. * **Option C:** Hypercellular glomeruli with neutrophils (exudative morphology) are typical of **Post-Streptococcal Glomerulonephritis (PSGN)**, which presents with hematuria and hypertension but not palpable purpura. **3. NEET-PG High-Yield Pearls:** * **HSP Tetrad:** Palpable purpura (non-thrombocytopenic), Arthralgia, Abdominal pain (may lead to intussusception), and Renal disease. * **Most common systemic vasculitis** in children. * **Renal Prognosis:** The long-term prognosis of HSP depends entirely on the severity of the renal involvement. * **Biopsy:** If performed, the renal biopsy of HSP is indistinguishable from IgA Nephropathy.

Question 1

A 70-year-old male, a known case of a certain malignancy, presents with elevated erythropoietin levels and a packed cell volume (PCV) of 52%. Which tumor is most likely responsible?

Accepted Answer

Renal Cell Carcinoma

Answer

Medullary thyroid carcinoma

Answer

Gastric Carcinoma

Answer

Colorectal Carcinoma

Question 2

Which of the following is NOT a feature of Potter syndrome?

Accepted Answer

Polyhydramnios

Answer

Bilateral renal agenesis

Answer

Pulmonary hypoplasia

Answer

Flattened facies

Question 3

Dense deposit disease is a characteristic finding in which of the following conditions?

Accepted Answer

Membranoproliferative Glomerulonephritis

Answer

Membranous Glomerulopathy

Answer

Mesangioproliferative Glomerulonephritis

Answer

No specific lesion

Question 4

Selective proteinuria is typically seen in which of the following conditions?

Accepted Answer

Nil lesion

Answer

Diabetic nephropathy

Answer

Focal segmental glomerulosclerosis

Answer

Mesangioproliferative glomerulonephritis

Question 5

Histopathologic examination of glomeruli shows crescents. This finding is characteristic of which of the following conditions?

Accepted Answer

Rapidly progressive glomerulonephritis

Answer

Minimal change disease

Answer

Membranous glomerulonephritis

Answer

Membranoproliferative glomerulonephritis

Question 6

In renal biopsy specimens, the Jones methenamine silver stain is used for which purpose?

Accepted Answer

To enhance basement membrane structure visualization

Answer

To assess cellularity and architecture

Answer

To stain carbohydrate moieties in the membranes of the glomerular tuft

Answer

To identify collagen deposition

Question 7

A 62-year-old patient from Wales, currently in the US, develops oliguria and peripheral edema over a period of weeks. Urinalysis reveals hematuria and proteinuria, and examination of the urinary sediment shows red cell casts. Renal biopsy demonstrates numerous glomerular crescents. What condition is most suggested by this presentation?

Accepted Answer

Rapidly progressive glomerulonephritis

Answer

Diabetic nephropathy

Answer

Hypertensive nephropathy

Answer

Lupus nephritis

Question 8

Loss of 'Y' chromosome is associated with which of the following types of renal cell carcinoma (RCC)?

Accepted Answer

Papillary RCC

Answer

Clear cell RCC

Answer

Chromophobe RCC

Answer

Collecting duct RCC

Question 9

Presence of nephroblastomatosis in a biopsy specimen from Wilm's tumor of the left kidney indicates a high possibility of?

Accepted Answer

Increased risk of tumor in the right kidney

Answer

Denys-Drash syndrome

Answer

Mutation in insulin-like growth factor

Answer

Lymph node metastasis

Question 10

An 8-year-old child presents with severe abdominal pain and palpable purpura. There is a history of recent, resolved diarrhea. What is the expected pathological finding in the kidney?

Accepted Answer

Mesangial deposits of IgA on electron microscopy

Answer

Podocyte effacement on electron microscopy

Answer

Electron dense deposits in the glomerular basement membrane on electron microscopy

Answer

Hypercellular glomeruli with neutrophils on light microscopy

Renal Pathology — MCQs

Renal Pathology — MCQs

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