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

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

Accepted Answer

IgA nephropathy

Answer

Amyloidosis

Answer

Diabetes mellitus

Answer

Membranous glomerulonephritis

Question 2

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 3

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 4

What is the most important cause of interstitial nephritis?

Accepted Answer

Drugs

Answer

Infection

Answer

Malignancy

Answer

Dehydration

Question 5

Which of the following is the least likely cause of necrotizing papillitis of the kidney?

Accepted Answer

Tuberculous pyelonephritis

Answer

Sickle cell disease

Answer

Diabetes mellitus

Answer

Analgesic nephropathy

Question 6

Which of the following findings is pathognomonic of renal disease?

Accepted Answer

Coarse granular casts

Answer

Hyaline casts

Answer

Cystine crystals

Answer

Epithelial cells

Question 7

Hypocomplementemia is seen in which of the following conditions?

Accepted Answer

Post-streptococcal glomerulonephritis (PSGN)

Answer

Membranous glomerulonephritis (MGN)

Answer

Focal segmental glomerulosclerosis (FSGS) with dense deposit disease

Answer

All of the above

Question 8

What is the characteristic histopathological finding of a "tram track appearance" in the kidney?

Accepted Answer

Membranoproliferative glomerulonephritis

Answer

Membranous nephropathy

Answer

IgA nephropathy

Answer

Crescentic glomerulonephritis

Question 9

Which of the following can cause Rapidly Progressive Glomerulonephritis (RPGN), except?

Accepted Answer

Minimal change glomerulonephritis

Answer

Poststreptococcal glomerulonephritis

Answer

Wegener granulomatosis

Answer

Systemic Lupus Erythematosus (SLE)

Question 10

Renal papillary necrosis is seen in which of the following conditions?

Accepted Answer

Sickle cell disease

Answer

Gouty nephropathy

Answer

Chronic glomerulonephritis

Answer

Tumor necrosis syndrome

Renal Pathology — MCQs

Renal Pathology — MCQs

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