Renal Pathology Practice Questions

Q: Which of the following is true about light microscopy findings in minimal change disease?

No significant changes are seen on light microscopy. **Explanation:** Minimal Change Disease (MCD) is the most common cause of nephrotic syndrome in children [1]. The diagnosis is primarily based on the characteristic findings across three modalities: Light Microscopy (LM), Immunofluorescence (IF), and Electron Microscopy (EM). **Why Option D is Correct:** The name "Minimal Change" is derived from the fact that the glomeruli appear **completely normal or show only "minimal" changes** (such as mild mesangial expansion) under **Light Microscopy** [2]. The tubules may occasionally show lipid accumulation (lipoid nephrosis), but the glomerular architecture remains preserved. **Analysis of Incorrect Options:** * **Option A:** While the loss (effacement) of podocyte foot processes is the hallmark finding of MCD, this is **only visible on Electron Microscopy (EM)**, not Light Microscopy [2]. The question specifically asks for LM findings. * **Option B:** Anti-GBM antibodies are characteristic of **Goodpasture Syndrome**, which presents as Rapidly Progressive Glomerulonephritis (RPGN), not MCD. * **Option C:** IgA deposits in the mesangium are the diagnostic feature of **IgA Nephropathy (Berger’s Disease)**. In MCD, Immunofluorescence is typically negative for all immunoglobulins and complements [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Hallmark:** Diffuse effacement of foot processes on **EM** [1]. * **Clinical Presentation:** Sudden onset massive proteinuria (selective for albumin) [2]. * **Treatment:** Highly steroid-responsive (Prednisolone is the drug of choice) [1], [2]. * **Associations:** Hodgkin Lymphoma and NSAID use. * **IF Finding:** Characteristically "Null" (Negative). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 927-928. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 922-923.

Q: Post-streptococcal glomerulonephritis is associated with which of the following?

Infection of the skin and throat. **Explanation:** **Post-streptococcal glomerulonephritis (PSGN)** is a classic example of a Type III hypersensitivity reaction (immune-complex mediated) [1] that occurs after an infection with **Group A Beta-hemolytic Streptococci (GABHS)**, specifically nephritogenic strains (e.g., Type 12 for throat, Type 49 for skin). 1. **Why Option A is correct:** PSGN typically follows either **Pharyngitis** (throat infection) or **Impetigo** (skin infection/pyoderma) [1]. The latent period differs: 1–2 weeks after pharyngitis and 3–6 weeks after skin infections. 2. **Why Option B is incorrect:** Antibiotics are used to treat the *initial* streptococcal infection and prevent the spread of the bacteria, but they **do not prevent or treat** the glomerulonephritis once the immune complexes have formed. Treatment for PSGN is primarily supportive (managing fluid overload and hypertension). 3. **Why Option C is incorrect:** PSGN has an excellent prognosis in children. More than **95% of children achieve complete recovery**. Only a very small minority (<1%) progress to chronic renal failure or rapidly progressive glomerulonephritis (RPGN). **High-Yield Clinical Pearls for NEET-PG:** * **Morphology:** Light microscopy shows "Starry sky" or "Garland" pattern; Electron microscopy shows characteristic **Subepithelial humps** [2]. * **Immunofluorescence:** Granular deposits of IgG and **C3** (Lumpy-bumpy appearance) [2]. * **Serology:** Low serum C3 levels (normalized within 6–8 weeks) and elevated ASO titers (after pharyngitis) or Anti-DNase B (after skin infection). * **Clinical Presentation:** Nephritic syndrome (hematuria/coca-cola colored urine, edema, and hypertension) [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 914-915. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, p. 915.

Question 1

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 2

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

Question 3

Which of the following is true about light microscopy findings in minimal change disease?

Accepted Answer

No significant changes are seen on light microscopy

Answer

Loss of foot processes is seen on electron microscopy

Answer

Anti-GBM antibodies are seen

Answer

IgA deposits are seen

Question 4

Flea-bitten kidney is seen in all of the following conditions except:

Accepted Answer

Diabetic nephropathy

Answer

Scleroderma renal crisis

Answer

Malignant hypertension

Answer

Hemolytic uremic syndrome

Question 5

Post-streptococcal glomerulonephritis is associated with which of the following?

Accepted Answer

Infection of the skin and throat

Answer

Remission induced by antibiotic treatment

Answer

A cause of chronic renal failure in the majority of children

Answer

All of the above

Question 6

Which of the following statements is NOT true about renal casts?

Accepted Answer

Casts are formed from albumin secreted by the glomeruli.

Answer

Hyaline casts can be found in normal physiological conditions.

Answer

Broad casts are characteristic of chronic renal failure.

Answer

Red blood cell casts are indicative of glomerulonephritis.

Question 7

All of the cystic diseases of the kidney cause enlargement of the kidney/renomegaly, except:

Accepted Answer

Nephronophthisis

Answer

Autosomal dominant polycystic kidney disease (ADPKD)

Answer

Autosomal recessive polycystic kidney disease (ARPKD)

Answer

Multicystic renal dysplasia

Question 8

Polycystic kidneys can be associated with which of the following complications?

Accepted Answer

Coarctation of the aorta

Answer

Cysts in the liver and lungs

Answer

Berry aneurysms

Answer

All of the above

Question 9

What type of nephropathy is characteristically seen in Diabetes Mellitus?

Accepted Answer

Nodular

Answer

Focal

Answer

Diffuse

Answer

Crescent

Question 10

In acute interstitial nephritis, which proteins are typically associated?

Accepted Answer

Light chains

Answer

Amyloid

Answer

Fibrinogen

Answer

Vitamin D binding protein

Renal Pathology — MCQs

Renal Pathology — MCQs

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