Renal Pathology Practice Questions

Q: Which of the following is NOT a characteristic feature of nephronophthisis?

Cortical tubular hypertrophy. **Explanation:** Nephronophthisis (NPHP) is an autosomal recessive tubulointerstitial cystic kidney disease and is the most common genetic cause of end-stage renal disease (ESRD) in children and adolescents. **Why Option B is correct:** In nephronophthisis, the kidneys are typically **shrunken and small** [1]. The hallmark pathological process is **cortical tubular atrophy**, not hypertrophy [1]. This atrophy, combined with widespread interstitial fibrosis, leads to the characteristic contraction of the renal parenchyma [1]. **Analysis of other options:** * **Option A (Interstitial fibrosis):** This is a cardinal feature of the disease [1]. Chronic tubulointerstitial nephritis leads to dense fibrosis, which eventually causes renal failure. * **Option C (Cysts in the medulla):** Small cysts (typically 1–15 mm) are characteristically found at the **corticomedullary junction** and in the medulla [1]. While essential for the name, they may be absent in early stages or visible only on biopsy/ultrasound [1]. * **Option D (20% non-familial):** While NPHP is primarily a genetic (autosomal recessive) disorder, approximately 20% of cases occur sporadically without a documented family history, often due to de novo mutations or small family sizes. **NEET-PG High-Yield Pearls:** 1. **Genetics:** Most common gene involved is **NPHP1** (encoding Nephrocystin-1). It is a **ciliopathy**. 2. **Clinical Presentation:** Polyuria and polydipsia (due to impaired urinary concentrating ability) are early signs. Unlike many other cystic diseases, hypertension is a late finding. 3. **Extra-renal associations:** Senior-Løken syndrome (NPHP + Retinitis pigmentosa) and Joubert syndrome (NPHP + Cerebellar ataxia). 4. **Imaging:** Small, shrunken kidneys with loss of corticomedullary differentiation [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 953-954.

Q: From which of the following does renal oncocytoma arise?

Collecting duct. ### Explanation **Correct Option: B. Collecting duct** Renal oncocytoma is a benign epithelial tumor that originates from the **intercalated cells of the collecting ducts**. These cells are rich in mitochondria, which gives the tumor its characteristic granular, eosinophilic cytoplasm on histopathology [1]. **Analysis of Incorrect Options:** * **A. Loop of Henle:** While various renal processes occur here, it is not the site of origin for common renal neoplasms. * **C. Proximal tubule:** This is the site of origin for **Renal Cell Carcinoma (RCC)**, specifically the **Clear Cell** and **Papillary** subtypes. This is a common distractor, as RCC is the most frequent primary renal malignancy. * **D. Bowman's capsule:** This structure is involved in filtration and is associated with crescent formation in glomerulonephritis, but not with the development of oncocytomas. **High-Yield Clinical Pearls for NEET-PG:** * **Gross Appearance:** Classically presents as a well-circumscribed, mahogany-brown tumor with a **central stellate scar**. * **Microscopy:** Composed of large cells (oncocytes) with abundant, granular, acidophilic cytoplasm. Electron microscopy reveals an **abundance of mitochondria**. * **Genetics:** Often associated with the loss of chromosomes 1 and Y. * **Differential Diagnosis:** It is difficult to distinguish from the **Chromophobe variant of RCC** (which also arises from collecting ducts) [1]. However, Chromophobe RCC typically shows "perinuclear halos" and stains positive with Hale’s Colloidal Iron, unlike oncocytoma. * **Prognosis:** Excellent, as it is a benign lesion [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, p. 959.

Q: Which of the following statements is false regarding hypernephroma?

It produces osteosclerotic secondaries on flat bone. **Explanation:** Hypernephroma, also known as **Renal Cell Carcinoma (RCC)**, is the most common primary renal malignancy. **Why Option D is False (The Correct Answer):** RCC is notorious for causing **osteolytic** (bone-destroying) metastases, not osteosclerotic ones. These lesions are characteristically "blow-out" in appearance, highly vascular, and can present with pathological fractures. In contrast, osteosclerotic (bone-forming) metastases are typically associated with Prostate Cancer. **Analysis of Other Options:** * **Option A:** Occupational exposure to **leather tanning chemicals**, cadmium, petroleum products, and asbestos are established risk factors for RCC. * **Option B:** Histologically, the most common subtype (Clear Cell RCC) originates from the **proximal convoluted tubular epithelium**. * **Option C:** RCC is a "great imitator" and often presents with paraneoplastic syndromes. It can produce **Erythropoietin**, leading to polycythemia (elevated Hb levels). **High-Yield Clinical Pearls for NEET-PG:** * **Classic Triad:** Hematuria (most common), loin pain, and a palpable mass (seen in only 10% of cases, usually advanced). * **Most Common Subtype:** Clear cell carcinoma (associated with VHL gene deletion on Chromosome 3p). * **Staging:** The most important prognostic factor is the stage at presentation. It has a unique propensity for **venous invasion** (renal vein and IVC). * **Paraneoplastic Syndromes:** Hypercalcemia (PTHrP), Hypertension (Renin), and Stauffer’s syndrome (reversible hepatic dysfunction without metastases). * **Treatment of Choice:** Radical nephrectomy (or partial nephrectomy for T1 tumors). It is generally resistant to chemotherapy and radiotherapy.

Question 1

Which of the following is NOT a characteristic feature of nephronophthisis?

Accepted Answer

Cortical tubular hypertrophy

Answer

Interstitial fibrosis

Answer

Cysts in the medulla

Answer

20% of cases are non-familial

Question 2

Xanthogranulomatous pyelonephritis is often associated with infection by which organism?

Accepted Answer

Proteus

Answer

E. coli

Answer

S. aureus

Answer

Klebsiella

Question 3

Which of the following is NOT true about post-streptococcal glomerulonephritis?

Accepted Answer

PSGN develops 1-3 weeks after a skin infection and 2-6 weeks after streptococcal pharyngitis

Answer

Proliferative glomerulonephritis

Answer

PSGN can be seen in the elderly

Answer

More common in males

Question 4

From which of the following does renal oncocytoma arise?

Accepted Answer

Collecting duct

Answer

Loop of Henle

Answer

Proximal tubule

Answer

Bowman's capsule

Question 5

Deficiency of Factor I and Factor H causes which condition?

Accepted Answer

Atypical Hemolytic Uremic Syndrome (HUS)

Answer

Typical Hemolytic Uremic Syndrome (HUS)

Answer

Thrombotic Thrombocytopenic Purpura (TTP)

Answer

Acute Thrombotic Thrombocytopenic Purpura (TTP)

Question 6

Which of the following statements is false regarding hypernephroma?

Accepted Answer

It produces osteosclerotic secondaries on flat bone

Answer

Leather workers have an increased risk

Answer

Arises from the proximal tubular epithelium

Answer

Hb levels may be elevated

Question 7

All the following are immune complex glomerulonephritis EXCEPT:

Accepted Answer

Good pasture's disease (RPGN)

Answer

Acute infectious glomerulonephritis

Answer

Membranous glomerulonephritis

Answer

SLE

Question 8

A patient diagnosed with bronchiectasis 5 years ago presents with leg edema and proteinuria. What is the most likely renal finding?

Accepted Answer

Amyloid Nephropathy

Answer

Minimal Change Disease

Answer

Rapidly Progressive Glomerulonephritis (RPGN)

Answer

Crescenteric Glomerulonephritis

Question 9

Increased IgA deposits are seen in which condition?

Accepted Answer

Henoch Schonlein Purpura

Answer

Minimal Change Glomerulonephritis

Answer

Chronic Pyelonephritis

Answer

Hemolytic Uremic Syndrome

Question 10

Where are the deposits typically found in IgA Nephropathy?

Accepted Answer

Mesangium

Answer

Subepithelial

Answer

Subendocardial

Answer

No deposits

Renal Pathology — MCQs

Renal Pathology — MCQs

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