Renal Pathology Practice Questions

Q: A 50-year-old male presented with blurring of vision. Urine examination showed proteinuria. Fundus examination showed dot-and-blot hemorrhages, microaneurysms, and cotton wool spots. What is the most probable diagnosis based on the provided histopathology?

Kimmelstiel-Wilson lesions. ***Kimmelstiel-Wilson lesions*** - These are **nodular glomerulosclerosis** lesions pathognomonic of **diabetic nephropathy**, correlating with the clinical picture of **diabetic retinopathy** (dot-and-blot hemorrhages, microaneurysms) and **proteinuria**. - The combination of **retinal changes** and **renal involvement** strongly indicates **diabetes mellitus** with end-organ damage, making Kimmelstiel-Wilson lesions the characteristic histopathological finding. *Crescents* - These are found in **rapidly progressive glomerulonephritis (RPGN)** and represent **epithelial cell proliferation** in Bowman's capsule. - Associated with **acute renal failure** and **hematuria**, not the chronic diabetic complications seen in this case. *Amyloid* - **Amyloid deposits** appear as **Congo red-positive** material with **apple-green birefringence** under polarized light. - Typically associated with **systemic amyloidosis** or **multiple myeloma**, not the diabetic retinopathy pattern described. *Segmental sclerosis* - This refers to **focal segmental glomerulosclerosis (FSGS)**, characterized by **sclerosis of glomerular segments**. - Commonly presents with **nephrotic syndrome** in younger patients without the characteristic **diabetic retinopathy** findings.

Q: What is the most common gene associated with renal cell carcinoma?

VHL. **Explanation:** The **VHL (Von Hippel-Lindau)** gene, located on **chromosome 3p25**, is the most significant tumor suppressor gene associated with Renal Cell Carcinoma (RCC). It is implicated in over 90% of sporadic Clear Cell RCC cases (via somatic mutation or hypermethylation) and is the hallmark of hereditary VHL syndrome. **Mechanism:** Under normal conditions, the VHL protein targets **HIF-1α (Hypoxia-Inducible Factor)** for degradation. Loss of VHL leads to stabilized HIF-1α, which translocates to the nucleus and upregulates growth factors like **VEGF** and **PDGF**, driving angiogenesis and tumor cell proliferation. **Analysis of Incorrect Options:** * **WT1 (Wilms Tumor 1):** Located on chromosome 11p13, this gene is associated with **Wilms tumor (Nephroblastoma)**, the most common primary renal tumor in children, not adult RCC. * **BRCA1:** Primarily associated with hereditary **breast and ovarian cancer** syndromes. While it increases the risk of certain epithelial cancers, it is not a primary driver of RCC. * **PATCH (PTCH1):** Mutations in the PTCH gene are associated with **Gorlin syndrome** (Basal Cell Nevus Syndrome) and medulloblastoma, rather than renal malignancies. **High-Yield Clinical Pearls for NEET-PG:** * **Clear Cell RCC:** Most common histological subtype; associated with **3p deletion**. * **Papillary RCC:** Associated with **MET proto-oncogene** mutations [1]. * **Chromophobe RCC:** Associated with multiple chromosome losses and better prognosis. * **Paraneoplastic Syndromes:** RCC is the "Great Mimicker," often presenting with polycythemia (EPO), hypercalcemia (PTHrP), or Cushing’s syndrome (ACTH). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 958-959.

Question 1

A 50-year-old male presented with blurring of vision. Urine examination showed proteinuria. Fundus examination showed dot-and-blot hemorrhages, microaneurysms, and cotton wool spots. What is the most probable diagnosis based on the provided histopathology?

Accepted Answer

Kimmelstiel-Wilson lesions

Answer

Crescents

Answer

Amyloid

Answer

Segmental sclerosis

Question 2

Which of the following conditions can cause Rapidly Progressive Glomerulonephritis (RPGN)?

Accepted Answer

All of the above

Answer

Wegener's granulomatosis

Answer

Goodpasture syndrome

Answer

Microscopic polyangiitis

Question 3

Anti-GBM antibodies are characteristically seen in which of the following conditions?

Accepted Answer

Goodpasture syndrome

Answer

Rapidly progressive glomerulonephritis (RPGN)

Answer

Membranous glomerulonephritis (MGN)

Answer

Minimal change disease

Question 4

Hemolytic uremic syndrome is characterized by which of the following?

Accepted Answer

Microangiopathic hemolytic anemia

Answer

Decreased lactate dehydrogenase (LDH)

Answer

Thrombocytopenia

Answer

Renal failure

Question 5

Necrotizing papillitis is seen in all of the following conditions except?

Accepted Answer

Paroxysmal Nocturnal Hemoglobinuria (PNH)

Answer

Salicylate poisoning

Answer

Renal vascular thrombosis

Answer

Diabetes mellitus

Question 6

An elderly male patient presented with blurring of vision. Fundus examination revealed cotton wool spots on retina and systemic examination showed decreased peripheral sensations and increased urine output. What finding is shown on renal biopsy?

Accepted Answer

Kimmelstiel-Wilson lesion

Answer

Amyloid deposits

Answer

Crescents

Answer

Hyaline atherosclerosis

Question 7

Which of the following shows crescent-shaped deposits under light microscopy?

Accepted Answer

Rapidly progressive glomerulonephritis (RPGN)

Answer

Acute glomerulonephritis

Answer

Membranous glomerulonephritis

Answer

Membranoproliferative glomerulonephritis

Question 8

Renal pathology in SLE includes all EXCEPT?

Accepted Answer

Lipoid nephrosis

Answer

Focal glomerulonephritis

Answer

Diffuse glomerulonephritis

Answer

Membranous glomerulonephritis

Question 9

What is the most common gene associated with renal cell carcinoma?

Accepted Answer

VHL

Answer

WT1

Answer

BRCA1

Answer

PATCH

Question 10

Which of the following is NOT a characteristic of acute humoral renal transplant rejection?

Accepted Answer

Interstitial and tubular mononuclear cell infiltrate

Answer

Presence of anti-donor antibodies

Answer

Necrotizing vasculitis

Answer

Acute cortical necrosis

Renal Pathology — MCQs

Renal Pathology — MCQs

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