Renal Pathology Practice Questions

Q: What is the most common tumor of the urinary bladder?

Transitional cell carcinoma. **Explanation:** **Correct Answer: C. Transitional cell carcinoma (TCC)** The urinary bladder is lined by a specialized epithelium known as **urothelium** (transitional epithelium). Consequently, **Transitional Cell Carcinoma (TCC)**, now more commonly referred to as **Urothelial Carcinoma**, is the most common histological type, accounting for approximately **90-95%** of all bladder cancers in developed countries. The primary risk factors for TCC include cigarette smoking and occupational exposure to aromatic amines (e.g., aniline dyes). **Incorrect Options:** * **A & D. Squamous cell carcinoma (SCC):** While SCC is the second most common type (~3-7%), it only becomes the most common in specific geographical regions where **Schistosomiasis (Schistosoma haematobium)** is endemic. Chronic irritation from long-term indwelling catheters or bladder stones also predisposes to SCC. * **B. Adenocarcinoma:** This is rare (<2%) and usually arises from the **urachus** (at the dome of the bladder) or in the setting of **bladder exstrophy** or cystitis glandularis. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** Cystoscopy with biopsy is the definitive diagnostic tool. * **Most Common Symptom:** Painless, gross hematuria (present in 85% of cases). * **Field Change Effect:** The entire urothelium (from renal pelvis to urethra) is at risk due to "field cancerization," meaning tumors are often multifocal and recurrent. * **Staging:** The **TNM system** is used; the involvement of the **detrusor muscle (T2)** is the critical prognostic factor that determines whether a patient needs radical cystectomy.

Q: According to WHO, which feature characterizes Class II lupus nephritis?

Hematuria. **Explanation:** Lupus Nephritis (LN) is classified by the WHO/ISN/RPS system based on histological findings. **Class II Lupus Nephritis** is defined as **Mesangial Proliferative Lupus Nephritis**. **Why Hematuria is Correct:** In Class II LN, immune complexes deposit exclusively in the **mesangium**, leading to mesangial hypercellularity and matrix expansion. Because the glomerular capillary wall and the visceral epithelial cells (podocytes) remain largely intact, patients do not typically present with nephrotic-range proteinuria. Instead, the clinical hallmark is **microscopic hematuria** with or without mild proteinuria. **Analysis of Incorrect Options:** * **A. Transient proteinuria:** Proteinuria in LN is usually persistent rather than transient, reflecting ongoing glomerular inflammation. * **B. Massive proteinuria:** This is characteristic of **Class V (Membranous LN)** or severe **Class III/IV (Focal/Diffuse Proliferative LN)** where there is significant podocyte injury or capillary wall damage. * **D. RBC casts:** These are a sign of "active" sediment or "nephritic syndrome," typically seen in **Class III and IV LN**, where there is endocapillary proliferation and necrosis. **High-Yield Facts for NEET-PG:** * **Class I (Minimal Mesangial):** Normal light microscopy; deposits seen only on Immunofluorescence (IF) or Electron Microscopy (EM). Usually asymptomatic. * **Class II (Mesangial Proliferative):** Mesangial hypercellularity. Clinical: Microscopic hematuria/mild proteinuria. * **Class III & IV (Focal & Diffuse Proliferative):** Most common and most severe forms. Present with hematuria, RBC casts, and hypertension. **Class IV is the most common.** * **Class V (Membranous):** Presents with nephrotic syndrome (massive proteinuria). * **Class VI (Advanced Sclerotic):** Global sclerosis of >90% of glomeruli; represents end-stage renal disease.

Question 1

What is the most common tumor of the urinary bladder?

Accepted Answer

Transitional cell carcinoma

Answer

Squamous cell carcinoma

Answer

Adenocarcinoma

Answer

Stratified squamous carcinoma

Question 2

Which of the following is NOT a pathological change seen in diabetic nephropathy?

Accepted Answer

Focal sclerosis

Answer

Fibrin caps and capsular drops

Answer

Intercapillary glomerulosclerosis

Answer

Capillary basement membrane thickening

Question 3

Renal pathology in SLE includes all EXCEPT?

Accepted Answer

Lipoid nephrosis

Answer

Focal glomerulonephritis

Answer

Diffuse glomerulonephritis

Answer

Membranous glomerulonephritis

Question 4

Distal and collecting duct cysts are seen in which condition?

Accepted Answer

Autosomal Recessive Polycystic Kidney Disease (ARPKD)

Answer

Autosomal Dominant Polycystic Kidney Disease (ADPKD)

Answer

Tuberous Sclerosis

Answer

Nephronophthisis

Question 5

Which of the following is NOT true about the condition shown?

Accepted Answer

Low Renin due to pressure atrophy of Juxtaglomerular apparatus

Answer

Cysts increase in size with age

Answer

Spider leg deformity

Answer

Anemia

Question 6

Pulsatile metastases are seen in which cancer?

Accepted Answer

Renal cancer

Answer

Lung cancer

Answer

Prostate cancer

Answer

Breast cancer

Question 7

What is the characteristic pathological finding in the kidney in malignant hypertension?

Accepted Answer

Flea-bitten kidney

Answer

Irregular granular contracted kidney

Answer

Large white kidney

Answer

No change in the kidney

Question 8

A child presents with an abdominal mass. Biopsy showed a triphasic tumor. Which of the following is a characteristic feature of this tumor?

Accepted Answer

WT1 mutation

Answer

MYCN amplification

Answer

C-MYC overexpression

Answer

RB deletion

Question 9

According to WHO, which feature characterizes Class II lupus nephritis?

Accepted Answer

Hematuria

Answer

Transient proteinuria

Answer

Massive proteinuria

Answer

RBC casts

Question 10

The characteristic feature of benign nephrosclerosis is

Accepted Answer

Leather grain appearance

Answer

Flea bitten kidney

Answer

Onion skin appearance

Answer

Hyperplastic arteriosclerosis

Renal Pathology — MCQs

Renal Pathology — MCQs

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