Renal Pathology Practice Questions

Q: Which of the following is a normal cast in urine?

Hyaline. **Explanation:** **Hyaline casts** are the most common type of urinary cast and are considered a **normal finding** when present in small numbers (0-2 per low-power field) [1]. They are composed entirely of **Tamm-Horsfall protein** (uromodulin) secreted by the thick ascending limb of the Loop of Henle [1]. They appear transparent, colorless, and cylindrical under the microscope. Their formation is often physiological, triggered by factors such as concentrated urine, strenuous exercise, fever, or dehydration. **Incorrect Options:** * **Granular Casts:** These represent the degeneration of cellular casts (usually tubular cells) [1]. While "fine" granular casts can occasionally be seen after exercise, they are generally considered a sign of **Acute Tubular Necrosis (ATN)** or chronic kidney disease. * **Waxy Casts:** These are the final stage of cast degeneration. They are broad, blunt-ended, and have a high refractive index. They are pathognomonic for **Chronic Renal Failure** and signify severe stasis in dilated tubules (End-stage renal disease). * **Epithelial Casts:** These contain shed renal tubular epithelial cells. They are always pathological and indicate significant tubular injury, such as **ATN**, ethylene glycol poisoning, or heavy metal ingestion. **High-Yield Clinical Pearls for NEET-PG:** * **RBC Casts:** Diagnostic of **Glomerulonephritis** (e.g., Post-streptococcal GN) [1]. * **WBC Casts:** Diagnostic of **Pyelonephritis** or Tubulointerstitial nephritis. * **Fatty Casts ("Maltese Cross"):** Characteristic of **Nephrotic Syndrome**. * **Broad Casts:** Seen in chronic renal failure (arise in dilated collecting ducts). **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. 520-525.

Question 1

Electron microscopy findings of renal biopsy shows permeation of the lamina densa of the glomerular basement membrane (GBM) by a ribbon-like, homogeneous, extremely electron-dense material of unknown composition. Which of the following is the likely diagnosis?

Accepted Answer

Dense-deposit disease (DDD)

Answer

Collapsing glomerulopathy

Answer

Minimal change disease

Answer

Focal segmental glomerulosclerosis (FSGS)

Question 2

Presence of islands of undifferentiated mesenchyme, often with cartilage, and immature collecting ducts on light microscopy will be seen in which cystic disease of the kidney?

Accepted Answer

Multicystic renal dysplasia

Answer

Medullary sponge kidney

Answer

Autosomal recessive polycystic kidney disease (ARPKD)

Answer

Autosomal dominant polycystic kidney disease (ADPKD)

Question 3

In Wegener's granulomatosis, which of the following is the characteristic histopathological feature seen in the glomeruli?

Accepted Answer

Focal necrotizing glomerulonephritis

Answer

Granulomas in the vessel wall

Answer

Nodular glomerulosclerosis

Answer

Interstitial granuloma

Question 4

Which of the following is NOT a cause of acute tubulointerstitial nephritis?

Accepted Answer

Down's syndrome

Answer

Methicillin

Answer

Sjogren syndrome

Answer

Systemic Lupus Erythematosus (SLE)

Question 5

Which of the following is a normal cast in urine?

Accepted Answer

Hyaline

Answer

Granular

Answer

Waxy

Answer

Epithelial

Question 6

Which of the following is NOT a cystic disease of the kidney?

Accepted Answer

Horseshoe kidney

Answer

Medullary sponge kidney

Answer

Nephrophthisis

Answer

Glomerulocystic disease

Question 7

In which class of lupus nephritis is thrombosis most commonly seen?

Accepted Answer

Class III

Answer

Class I

Answer

Class II

Answer

Class IV

Question 8

Kimmelstiel-Wilson lesions in the kidney consist of?

Accepted Answer

Nodular glomerulosclerosis

Answer

Splitting of glomerular basement membrane

Answer

Hyaline arteriolosclerosis

Answer

Hyperplastic arteriolosclerosis

Question 9

Which of the following renal pathologies is present in a child who developed nephrotic syndrome after hepatitis B infection?

Accepted Answer

Membranous nephropathy

Answer

Focal segmental glomerulosclerosis

Answer

IgA nephropathy

Answer

Membranoproliferative glomerulonephritis

Question 10

Cylindrical dilatation of renal tubules is seen in?

Accepted Answer

Polycystic disease of kidney

Answer

Medullary cystic disease

Answer

Wilms tumour

Answer

Lipoid nephrosis

Renal Pathology — MCQs

Renal Pathology — MCQs

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