Renal Pathology Practice Questions

Q: Which renal pathology has the highest risk of recurrence following renal transplantation?

MPGN. **Explanation:** The correct answer is **MPGN (Membranoproliferative Glomerulonephritis)**. **Why MPGN is the correct answer:** MPGN, particularly **Type II (Dense Deposit Disease)**, has the highest recurrence rate among all primary glomerular diseases following renal transplantation, approaching **80–100%**. The underlying pathophysiology involves the **alternative complement pathway** (often due to C3 nephritic factor), which remains active in the patient's circulation post-transplant, leading to rapid destruction of the graft [2]. MPGN Type I also recurs frequently (approx. 30–50%). **Analysis of Incorrect Options:** * **Goodpasture’s Syndrome:** Recurrence is rare if the transplant is delayed until anti-GBM antibodies are undetectable in the serum for at least 6–12 months [1]. * **Alport’s Syndrome:** This is a genetic defect in Type IV collagen. Since the donor kidney has normal collagen, the disease itself cannot "recur." However, these patients may develop *de novo* anti-GBM disease (Post-transplant Alport’s) because their immune system sees the normal collagen as foreign. * **Amyloidosis:** While systemic amyloidosis can involve the graft, the rate of recurrence and graft loss is significantly lower than that of MPGN. **NEET-PG High-Yield Pearls:** * **Highest Recurrence Risk:** MPGN Type II (Dense Deposit Disease) [2]. * **Most Common Cause of Graft Failure (Recurrence):** FSGS (recurs in ~30% of cases but is a leading cause of early graft loss). * **IgA Nephropathy:** Very common histological recurrence (~50%), but rarely leads to actual graft failure. * **Least likely to recur:** Post-streptococcal glomerulonephritis (PSGN). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 931-933. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 926-927.

Question 1

In which of the primary glomerulonephritis are the glomeruli normal by light microscopy, showing loss of foot processes of the visceral epithelial cells and no deposits by electron microscopy?

Accepted Answer

Minimal change disease

Answer

Poststreptococcal glomerulonephritis

Answer

Membranoproliferative glomerulonephritis type I

Answer

IgA nephropathy

Question 2

Which of the following are suspected carcinogens for bladder carcinoma?

Accepted Answer

All the above

Answer

Phenacitin

Answer

Tobacco

Answer

Aniline dye

Question 3

A 35-year-old female recovering from hepatitis B develops hematuria, proteinuria, and red cell casts in the urine. Which of the following would best describe the changes within the kidney in this patient?

Accepted Answer

Granular deposits of antibodies in the glomerular basement membrane

Answer

Plasma cell interstitial nephritis

Answer

IgG linear fluorescence along the glomerular basement membrane

Answer

Diffuse thickening of the glomerular basement membrane by subepithelial immune deposits

Question 4

A 28-year-old man complains of nasal obstruction, bloody nose, cough, and bloody sputum. A chest X-ray displays cavitated lesions and multiple nodules within both lung fields. Urinalysis reveals 3+ hematuria and red blood cell casts. Laboratory studies show anemia and elevated serum levels of C-ANCA. Peripheral eosinophils are not increased. A renal biopsy exhibits focal glomerular necrosis with crescents and vasculitis affecting arterioles and venules. Which of the following best describes the renal disease of the patient?

Accepted Answer

Rapidly progressive glomerulonephritis

Answer

Chronic nephritic syndrome

Answer

Nephrotic syndrome

Answer

Type I membranoproliferative glomerulonephritis

Question 5

Which of the following is NOT a feature of Rapidly Progressive Glomerulonephritis (RPGN)?

Accepted Answer

Rapid recovery

Answer

Crescent formation

Answer

High blood pressure

Answer

Non-selective proteinuria

Question 6

What condition is characterized by marked endocapillary proliferation on renal biopsy?

Accepted Answer

Acute poststreptococcal glomerulonephritis

Answer

Membranous glomerulonephritis

Answer

Focal segmental glomerulosclerosis

Answer

Mesangioproliferative glomerulonephritis

Question 7

Proliferative glomerular deposits are found in which of the following conditions?

Accepted Answer

IgA nephropathy

Answer

Amyloidosis

Answer

Diabetes mellitus

Answer

Membranous glomerulonephritis

Question 8

Which renal pathology has the highest risk of recurrence following renal transplantation?

Accepted Answer

MPGN

Answer

Goodpasture's syndrome

Answer

Alport's syndrome

Answer

Amyloidosis

Question 9

A 2 kg baby, born at 30 weeks gestation to an 18-year-old primigravida, died after 48 hours. Apgar scores were 5 and 8 at 1 and 5 minutes, respectively. Autopsy revealed bilateral enlarged kidneys with multiple radially arranged cysts. Which of the following findings is expected to be associated?

Accepted Answer

Hepatic cyst and fibrosis

Answer

Imperforate anus

Answer

Absence of ureter

Answer

Holoprosencephaly

Question 10

What is the most important cause of interstitial nephritis?

Accepted Answer

Drugs

Answer

Infection

Answer

Malignancy

Answer

Dehydration

Renal Pathology — MCQs

Renal Pathology — MCQs

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