Renal Pathology Practice Questions

Q: Which of the following is NOT a feature of Minimal Change Disease?

NSAIDs are a primary cause. **Explanation:** Minimal Change Disease (MCD) is the most common cause of nephrotic syndrome in children [1]. Understanding its pathogenesis and clinical features is crucial for NEET-PG. **Why Option D is the correct answer:** While NSAIDs are indeed associated with MCD, they are considered a **secondary cause**, not a primary (idiopathic) cause. Primary MCD is typically idiopathic, often linked to T-cell dysfunction and the release of glomerular permeability factors. Secondary causes include drugs (NSAIDs, Lithium), malignancies (Hodgkin Lymphoma), and allergies. **Analysis of other options:** * **Option A (Good response to steroids):** This is a hallmark of MCD. Over 90% of children show a dramatic response to corticosteroid therapy [1], which is a key diagnostic and therapeutic feature. * **Option B (Morphology):** MCD is characterized by a "minimal" change. Under **Light Microscopy**, the glomeruli appear completely **normal**. However, **Electron Microscopy** reveals the diagnostic feature: **diffuse effacement (fusion) of podocyte foot processes** [1]. * **Option C (Nil deposit disease):** This is an alternative name for MCD because **Immunofluorescence (IF)** shows no significant deposits of immunoglobulins or complement (Negative/Nil deposits) [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Most common presentation:** Sudden onset of heavy proteinuria (selective proteinuria, mainly albumin) [1]. * **Pathogenesis:** Loss of the glomerular polyanionic charge (heparan sulfate), leading to albumin leakage. * **Lipiduria:** "Maltese cross" appearance under polarized light due to cholesterol esters in urine. * **Prognosis:** Excellent in children; however, adults may take longer to respond to steroids and have a higher rate of relapse [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 922-928.

Q: A 4-year-old girl presents with swelling of the legs and ankles. Physical examination reveals pitting edema of the lower extremities. Urinalysis shows 2+ proteinuria. The urinary sediment contains no inflammatory cells or red blood cells. Serum levels of BUN and creatinine are normal. The patient recovers completely after a course of corticosteroids. Which of the following pathologic findings might be expected in the urine prior to treatment with corticosteroids?

Lipid droplets. **Explanation:** The clinical presentation of a 4-year-old child with sudden onset pitting edema, heavy proteinuria (2+), and a complete response to corticosteroids, in the absence of hematuria or azotemia, is classic for **Minimal Change Disease (MCD)**. MCD is the most common cause of nephrotic syndrome in children. **Why Lipid Droplets are the Correct Answer:** In nephrotic syndrome, the massive loss of albumin triggers the liver to increase lipoprotein synthesis, leading to **hyperlipidemia**. These lipids filter through the damaged glomerular basement membrane. Within the tubular lumen, they are seen as **free lipid droplets**, or they may be engulfed by tubular epithelial cells to form **oval fat bodies**. Under polarized light, these lipids exhibit a characteristic "Maltese cross" appearance. **Analysis of Incorrect Options:** * **Amyloid casts:** These are associated with systemic amyloidosis, which typically presents in older adults with chronic inflammatory conditions, not in a steroid-responsive pediatric patient. * **Eosinophils:** These are a hallmark of **Acute Interstitial Nephritis (AIN)**, usually triggered by a drug reaction, and are not a feature of primary nephrotic syndrome. * **Red blood cell casts:** These indicate **nephritic syndrome** (glomerulonephritis), characterized by hematuria, hypertension, and azotemia, all of which are absent in this case. **NEET-PG High-Yield Pearls:** * **MCD Hallmark:** Effacement (fusion) of podocyte foot processes on **Electron Microscopy**. * **Light Microscopy:** Appears normal (hence the name "Minimal Change"). * **Immunofluorescence:** Negative (no immune deposits). * **Treatment:** Oral Prednisolone is the first-line therapy; MCD is highly steroid-sensitive. * **Selective Proteinuria:** MCD typically shows selective loss of albumin rather than globulins.

Q: Silver stain performed on renal biopsy shows characteristic findings. Immunostaining for Anti-PLA2R is positive. Based on the given findings, what is the likely diagnosis?

Membranous nephropathy. ***Membranous nephropathy*** - **Anti-PLA2R antibody** positivity is highly specific for **primary membranous nephropathy**, making it the diagnostic marker of choice. - Silver stain reveals the characteristic **spike-and-dome pattern** with thickened basement membrane projections between immune deposits. *Focal segmental glomerulosclerosis (FSGS)* - Shows **segmental sclerosis** and **hyalinosis** on silver stain, not the spike-and-dome pattern seen in membranous nephropathy. - **Anti-PLA2R** is typically negative in FSGS, as it lacks the characteristic immune complex deposits of membranous disease. *Membranoproliferative glomerulonephritis (MPGN)* - Silver stain demonstrates **double contour** or **tram-track** appearance of the basement membrane, distinct from spike-and-dome. - **Anti-PLA2R** is negative in MPGN, which involves different complement-mediated pathways and immune complex patterns. *Crescentic glomerulonephritis* - Characterized by **epithelial crescents** filling Bowman's space on silver stain, not basement membrane thickening. - **Anti-PLA2R** is not associated with crescentic GN, which typically involves **ANCA** or **anti-GBM antibodies** instead.

Question 1

Which of the following is NOT a feature of Minimal Change Disease?

Accepted Answer

NSAIDs are a primary cause

Answer

Good response to steroids

Answer

Effacement of podocytes on electron microscope, normal on light microscope

Answer

Nil deposit disease

Question 2

A 4-year-old girl presents with swelling of the legs and ankles. Physical examination reveals pitting edema of the lower extremities. Urinalysis shows 2+ proteinuria. The urinary sediment contains no inflammatory cells or red blood cells. Serum levels of BUN and creatinine are normal. The patient recovers completely after a course of corticosteroids. Which of the following pathologic findings might be expected in the urine prior to treatment with corticosteroids?

Accepted Answer

Lipid droplets

Answer

Amyloid casts

Answer

Eosinophils

Answer

Red blood cell casts

Question 3

Nephrotic syndrome is characterized by

Accepted Answer

Hematuria

Answer

Massive proteinuria

Answer

Edema

Answer

Hyperlipidemia

Question 4

All are features of hemolytic uremic syndrome, EXCEPT?

Accepted Answer

Neuropsychiatric disturbances

Answer

Hyperkalemia

Answer

Anemia

Answer

Renal microthrombi

Question 5

Minimal-change nephropathy is characterized by which of the following?

Accepted Answer

Produces highly selective proteinuria

Answer

Is the commonest cause of the nephrotic syndrome in childhood

Answer

Does not relapse after remission

Answer

Does not cause depression of the serum complement level

Question 6

A 7-year-old boy has become less active over the past 10 days. On physical examination, the boy has facial puffiness. Urinalysis shows no blood, glucose, or ketones, and microscopic examination shows no casts or crystals. The serum creatinine level is normal. A 24-hour urine collection yields 3.8 g of protein. He improves after corticosteroid therapy. He has two more episodes of proteinuria over the next 4 years, both of which respond to corticosteroid therapy. What is the most likely mechanism causing his disease?

Accepted Answer

Cytokine-mediated visceral epithelial cell injury

Answer

Cytotoxic T cell-mediated tubular epithelial cell injury

Answer

IgA-mediated mesangial cell injury

Answer

Immune complex-mediated glomerular injury

Question 7

A 28-year-old man presents with a large amount of blood and protein in his urine. He has had sensorineural hearing loss since his teen years and anterior lenticonus. The physician suspects a genetic disorder that may lead to eventual kidney failure. If this is the case, the patient most likely has a mutation in which one of the following proteins?

Accepted Answer

Collagen

Answer

Spectrin

Answer

a1-Antitrypsin

Answer

Fibrillin

Question 8

Silver stain performed on renal biopsy shows characteristic findings. Immunostaining for Anti-PLA2R is positive. Based on the given findings, what is the likely diagnosis?

Accepted Answer

Membranous nephropathy

Answer

Focal segmental glomerulosclerosis (FSGS)

Answer

Membranoproliferative glomerulonephritis (MPGN)

Answer

Crescentic glomerulonephritis

Question 9

Rapidly progressive glomerulonephritis can be associated with all of the following, except?

Accepted Answer

Diabetic nephropathy

Answer

Goodpasture syndrome

Answer

Lupus nephritis

Answer

Post-infectious glomerulonephritis

Question 10

Dysmorphic RBCs are seen in which of the following conditions?

Accepted Answer

IgA glomerulopathy

Answer

Membranous glomerulopathy

Answer

Nil lesion glomerulopathy

Answer

None of the above

Renal Pathology — MCQs

Renal Pathology — MCQs

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