Renal Pathology Practice Questions

Q: A child with nephrotic syndrome developed anasarca. What is the main cause of edema in nephrotic syndrome?

Decreased plasma proteins. ### Explanation The primary mechanism of edema in Nephrotic Syndrome is explained by the **Classical (Underfill) Hypothesis**. **1. Why "Decreased plasma proteins" is correct:** Nephrotic syndrome is characterized by massive proteinuria (due to podocyte injury). This leads to **Hypoalbuminemia** (decreased plasma proteins). According to Starling’s Law, plasma albumin is the main determinant of **Plasma Colloid Osmotic Pressure (PCOP)**. When PCOP falls below a critical level, the inward pulling force in the capillaries is lost, causing fluid to leak into the interstitial space, resulting in edema and anasarca. **2. Analysis of Incorrect Options:** * **A. Sodium and water retention:** While this occurs, it is a *secondary* response. In the "Underfill" model, decreased intravascular volume triggers the Renin-Angiotensin-Aldosterone System (RAAS), leading to sodium retention to compensate for the fluid shift. (Note: The "Overfill" theory suggests primary sodium retention, but hypoalbuminemia remains the initiating factor in the classic pediatric presentation). * **B. Increased venous pressure:** This is the mechanism for edema in Congestive Heart Failure (CHF), not nephrotic syndrome. * **C. Hyperlipidemia:** This is a diagnostic feature of nephrotic syndrome (due to reactive hepatic synthesis of lipids), but it does not contribute to the formation of edema. **Clinical Pearls for NEET-PG:** * **Definition:** Nephrotic range proteinuria is >40 mg/m²/hr or a spot protein/creatinine ratio >2. * **First sign:** Edema in nephrotic syndrome typically starts as **periorbital puffiness**, most prominent in the morning. * **The "Overfill" Theory:** In some adults or specific types of nephrotic syndrome, primary renal sodium retention (independent of albumin) is the cause; however, for exam purposes, **Hypoalbuminemia/Decreased PCOP** is the standard answer for the "main cause."

Q: Which of the following statements about renal cell carcinoma is FALSE?

Bellini duct carcinoma arises from the loop of Henle.. **Explanation:** Renal Cell Carcinoma (RCC) is a heterogeneous group of tumors arising from the renal tubular epithelium. Understanding the specific anatomical origin of each subtype is high-yield for NEET-PG. **Why Option D is the Correct (False) Statement:** Bellini duct carcinoma (also known as **Collecting Duct Carcinoma**) is a rare, highly aggressive subtype of RCC. It arises from the **collecting ducts** (specifically the principal cells) located in the renal medulla, **not the loop of Henle**. **Analysis of Other Options:** * **Option A:** Risk factors for RCC include smoking (most common), obesity, hypertension, and occupational exposure to **asbestos, cadmium, and petroleum products**. **Sickle cell trait/disease** is specifically associated with Renal Medullary Carcinoma. * **Option B:** **Clear cell RCC** (the most common subtype, 75-80%) and **Papillary RCC** both originate from the **Proximal Convoluted Tubule (PCT)**. In contrast, Chromophobe RCC arises from the intercalated cells of the collecting duct. * **Option C:** RCC is known for hematogenous spread. **"Cannonball metastases"** refer to well-circumscribed, large, round secondary deposits in the lungs, which are a classic radiological feature of metastatic RCC. **High-Yield Clinical Pearls for NEET-PG:** * **Classic Triad:** Hematuria, flank pain, and palpable mass (seen in only 10% of cases; signifies advanced disease). * **Most common site of metastasis:** Lung. * **Stauffer Syndrome:** Reversible hepatic dysfunction (elevated LFTs) in the absence of liver metastases. * **Genetic Association:** Clear cell RCC is associated with the **VHL gene** deletion on **Chromosome 3p**. * **Treatment of Choice:** Radical nephrectomy (or partial nephrectomy for T1 tumors). RCC is notoriously resistant to chemotherapy and radiotherapy.

Question 1

A child with nephrotic syndrome developed anasarca. What is the main cause of edema in nephrotic syndrome?

Accepted Answer

Decreased plasma proteins

Answer

Sodium and water retention

Answer

Increased venous pressure

Answer

Hyperlipidemia

Question 2

IgA deposition in mesangial cells is seen in which condition?

Accepted Answer

Berger disease

Answer

Goodpasture syndrome

Answer

Crescentic glomerulonephritis

Answer

Alport syndrome

Question 3

Proteinuria caused by tubule-interstitial renal disease is confirmed by the excretion of which of the following?

Accepted Answer

Light chain

Answer

Albumin

Answer

Immunoglobulin A

Answer

Tamm-Horsfall protein

Question 4

A four-year-old child develops steroid-sensitive nephrotic syndrome. Renal biopsy studies demonstrate normal-appearing glomeruli by light microscopy and fusion of foot processes by electron microscopy. Which of the following proteins would be present in the urine in the highest concentration?

Accepted Answer

Albumin

Answer

Ceruloplasmin

Answer

IgA

Answer

Kappa light chain

Question 5

Which type of renal cell carcinoma is associated with the worst prognosis?

Accepted Answer

Collecting duct RCC

Answer

Clear cell carcinoma

Answer

Chromophobe type RCC

Answer

Papillary RCC

Question 6

Which of the following statements about renal cell carcinoma is FALSE?

Accepted Answer

Bellini duct carcinoma arises from the loop of Henle.

Answer

Asbestos, sickle cell anemia, and petroleum products are risk factors.

Answer

Clear cell carcinoma arises from the proximal convoluted tubule.

Answer

Cannonball metastases are characteristic.

Question 7

All of the following statements regarding membranous nephropathy are true except?

Accepted Answer

Rupture of the glomerular basement membrane is a characteristic feature.

Answer

It is the most common cause of nephrotic syndrome in adults.

Answer

Antibodies to phospholipase A2 receptor are present.

Answer

A 'spike and dome' appearance is visualized on electron microscopy.

Question 8

Focal glomerulonephritis can be seen in all of the following conditions EXCEPT-

Accepted Answer

Hypertension

Answer

Wegener's granulomatosis

Answer

Infective endocarditis

Answer

IgA nephropathy

Question 9

Increased renin activity is seen in which of the following conditions?

Accepted Answer

Malignant nephrosclerosis

Answer

Benign nephrosclerosis

Answer

Hemolytic Uremic Syndrome (HUS)

Answer

Malignant hypertension (MHA)

Question 10

All of the following statements are true about post-streptococcal glomerulonephritis except?

Accepted Answer

All cases of streptococcal infection lead to glomerulonephritis.

Answer

Early treatment of streptococcal pharyngitis prevents glomerulonephritis.

Answer

Hump sign may be present.

Answer

Immune complex deposits are seen.

Renal Pathology — MCQs

Renal Pathology — MCQs

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