Renal Pathology Practice Questions

Q: Renal calculi associated with Proteus infection are typically composed of which substance?

Triple phosphate. **Explanation:** **Triple phosphate stones** (also known as **Struvite** or **Staghorn calculi**) are the hallmark of infections caused by urea-splitting organisms, most notably ***Proteus mirabilis***. **Why Triple Phosphate is Correct:** *Proteus* produces the enzyme **urease**, which hydrolyzes urea into ammonia and carbon dioxide. This process increases the urinary pH (alkaline urine, pH > 7.2). In this alkaline environment, the solubility of magnesium, ammonium, and phosphate decreases, leading to the precipitation of **Magnesium Ammonium Phosphate** (Triple Phosphate). These stones often grow rapidly to fill the renal pelvis and calyces, forming a "Staghorn" appearance. **Why Other Options are Incorrect:** * **A. Uric acid:** These stones form in **acidic urine** (low pH). They are radiolucent on X-ray and are associated with gout or high cell turnover. * **C. Calcium oxalate:** This is the **most common** type of renal stone overall. Their formation is generally independent of infection and is often linked to hypercalciuria or hyperoxaluria. * **D. Xanthine:** These are rare stones caused by a genetic deficiency of xanthine oxidase or the use of allopurinol. **High-Yield Clinical Pearls for NEET-PG:** * **Composition:** Triple phosphate stones consist of Magnesium Ammonium Phosphate and Calcium Phosphate (Carbonate apatite). * **Radiology:** They are **radio-opaque** (though less dense than calcium oxalate) and typically present as a **Staghorn calculus** on KUB X-ray. * **Microscopy:** Crystals appear as **"Coffin-lid"** shaped. * **Management:** Since the stone itself acts as a reservoir for bacteria, complete surgical removal (e.g., PCNL) is usually necessary to eradicate the infection.

Q: Renal biopsy findings are shown in this image. What is the most probable diagnosis?

Renal amyloidosis. ***Renal amyloidosis*** - Shows characteristic **amorphous eosinophilic deposits** in the **mesangium** and **capillary walls** on H&E staining. - **Congo red stain** demonstrates **apple-green birefringence** under polarized light, pathognomonic for amyloid deposits. *Renal tuberculosis* - Histology shows **epithelioid granulomas** with **Langhans giant cells** and **caseous necrosis**. - Lacks the characteristic **amorphous eosinophilic deposits** and **Congo red positivity** seen in amyloidosis. *Renal cell carcinoma* - Shows **clear cell** or **granular cell** morphology with **prominent vasculature** and **lipid-rich cytoplasm**. - Presents as a **solid mass lesion** rather than diffuse **glomerular** and **tubular deposits**. *Crescentic glomerulonephritis* - Characterized by **cellular crescents** in **Bowman's space** with **proliferating epithelial cells**. - Shows **acute inflammatory infiltrate** and **fibrinoid necrosis**, not amorphous deposits.

Question 1

Cholemic nephrosis is seen in:

Accepted Answer

Obstructive jaundice

Answer

Malaria

Answer

Addison's disease

Answer

Hemochromatosis

Question 2

Which of the following is a cause of leprosy?

Accepted Answer

Focal glomerulosclerosis

Answer

Rapidly progressive glomerulonephritis

Answer

Membranoproliferative glomerulonephritis

Answer

Acute glomerulonephritis

Question 3

KIM-1 is a novel biomarker for which of the following conditions?

Accepted Answer

Acute kidney injury

Answer

Chronic kidney injury

Answer

Renal cellular carcinoma

Answer

Renal metastasis

Question 4

Renal calculi associated with Proteus infection are typically composed of which substance?

Accepted Answer

Triple phosphate

Answer

Uric acid

Answer

Calcium oxalate

Answer

Xanthine

Question 5

Which of the following conditions is associated with pauci-immune crescentic glomerulonephritis?

Accepted Answer

Microscopic polyangiitis

Answer

Henoch-Schönlein Nephritis

Answer

Lupus Nephritis (SLE)

Answer

Nephritis in Alport syndrome

Question 6

A patient presented with hematuria and acute renal failure. Renal biopsy showed crescentic glomerulonephritis with immunofluorescence findings of C3 and IgG deposition. What is the most likely diagnosis?

Accepted Answer

Acute post-infectious glomerulonephritis

Answer

Membranous glomerulonephritis

Answer

Minimal change disease

Answer

Monoclonal deposition disease

Question 7

Renal biopsy findings are shown in this image. What is the most probable diagnosis?

Accepted Answer

Renal amyloidosis

Answer

Renal tuberculosis

Answer

Renal cell carcinoma

Answer

Crescentic glomerulonephritis

Question 8

In the rejection phenomenon after kidney transplant, what is the primary target for early immunological attack?

Accepted Answer

Vascular endothelium

Answer

Renal papillae

Answer

Glomeruli

Answer

Proximal tubules

Question 9

Which of the following statements about Renal Cell Carcinoma (Hypernephroma) is false?

Accepted Answer

Is radiosensitive

Answer

Originates in the cortex

Answer

Histologically are usually adenocarcinomas

Answer

May present with varicocele

Question 10

Which of the following is a feature of septic shock?

Accepted Answer

Acute tubular necrosis

Answer

Acute cortical necrosis

Answer

Acute glomerulonephritis

Answer

Acute papillary necrosis

Renal Pathology — MCQs

Renal Pathology — MCQs

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