Renal Pathology Practice Questions

Q: Red cell casts are most commonly associated with which of the following conditions?

Nephritic syndrome. **Explanation:** **Red cell casts** are the hallmark of **Nephritic Syndrome (Glomerulonephritis)**. Their presence indicates bleeding originating from the glomerulus rather than the lower urinary tract [1]. When the glomerular filtration barrier is damaged (as seen in conditions like Post-streptococcal Glomerulonephritis or IgA Nephropathy), RBCs leak into the nephron [1]. As they pass through the distal convoluted tubule and collecting ducts, they are trapped within a matrix of **Tamm-Horsfall protein**, forming cylindrical casts that are subsequently excreted in the urine. **Analysis of Incorrect Options:** * **A. Acute Tubular Necrosis (ATN):** Characterized by **"Muddy brown" granular casts** or epithelial cell casts due to the sloughing of necrotic tubular cells [1]. * **B. Nephrotic Syndrome:** Typically presents with **Fatty casts**, "Maltese cross" appearance under polarized light (due to lipiduria), and oval fat bodies. * **C. Interstitial Nephritis:** Classically associated with **WBC casts** (specifically eosinophils in drug-induced cases) and sterile pyuria. **High-Yield Clinical Pearls for NEET-PG:** * **RBC Casts = Glomerular Hematuria:** Always look for dysmorphic RBCs (acanthocytes) on microscopy alongside these casts. * **WBC Casts:** Suggest Pyelonephritis or Interstitial Nephritis (helps differentiate upper UTI from lower UTI/Cystitis). * **Waxy Casts:** Seen in Chronic Renal Failure (represent advanced tubular atrophy). * **Hyaline Casts:** Non-specific; can be seen in normal concentrated urine, dehydration, or after vigorous exercise [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 520-521.

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.

Question 1

Red cell casts are most commonly associated with which of the following conditions?

Accepted Answer

Nephritic syndrome

Answer

Acute tubular necrosis

Answer

Nephrotic syndrome

Answer

Interstitial nephritis

Question 2

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 3

Which of the following pathological processes is responsible for acute glomerulonephritis?

Accepted Answer

Immune complex disease

Answer

Vascular thrombosis

Answer

Infective

Answer

Neoplastic

Question 4

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 5

If a renal biopsy shows distinct crescents, what is the most likely diagnosis?

Accepted Answer

Rapidly progressive glomerulonephritis (RPGN)

Answer

Membranoproliferative glomerulonephritis (MPGN)

Answer

Post-streptococcal glomerulonephritis (PSGN)

Answer

Minimal change disease

Question 6

What is the most common cause of glomerulonephritis?

Accepted Answer

Post-streptococcal glomerulonephritis

Answer

Diabetes mellitus

Answer

Autosomal dominant polycystic kidney disease

Answer

Crescentric glomerulonephritis

Question 7

IgA nephropathy is characterized by which of the following glomerular changes?

Accepted Answer

Mesangioproliferative glomerulonephritis

Answer

Membranoproliferative glomerulonephritis

Answer

Minimal change glomerulonephritis

Answer

Rapidly progressive glomerulonephritis type I

Question 8

Which of the following is rarely associated with renal cell carcinoma?

Accepted Answer

Cushing's syndrome

Answer

Polycythemia

Answer

Amyloidosis

Answer

Hypertension

Question 9

What is true about nephrogenic rest?

Accepted Answer

Associated with Wilm's tumor

Answer

Increased risk of Wilm's tumor in contralateral kidney

Answer

No association with Wilm's tumor

Answer

Abnormal embryonal renal tissue

Question 10

On kidney biopsy, which of the following structures stains PAS-positive?

Accepted Answer

Tubule

Answer

Glomerular basement membrane

Answer

Neutrophils

Answer

Interstitium

Renal Pathology — MCQs

Renal Pathology — MCQs

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