Renal Pathology Practice Questions

Q: What is the most common histological variant of renal cell carcinoma (RCC)?

Clear cell. **Explanation:** Renal Cell Carcinoma (RCC) is the most common primary malignancy of the kidney, arising from the renal tubular epithelium. **1. Why Clear Cell is Correct:** **Clear cell RCC** is the most common histological subtype, accounting for approximately **70-80%** of all cases. It typically arises from the **proximal convoluted tubule**. Microscopically, it is characterized by cells with clear cytoplasm (due to high glycogen and lipid content) and a prominent delicate vascular pattern (chicken-wire vessels) [1]. Most sporadic cases are associated with deletions or mutations of the **VHL gene on chromosome 3p**. **2. Why the other options are incorrect:** * **Papillary RCC (10-15%):** The second most common variant [1]. It often presents as multifocal or bilateral tumors and is associated with trisomy 7 and 17. * **Chromophobe RCC (5%):** Arises from intercalated cells of the collecting ducts [1]. It has a better prognosis and is characterized by "pale" cells with prominent cell membranes (vegetable-like) and perinuclear halos [1]. * **Collecting Duct (Bellini) Carcinoma (<1%):** An extremely rare and highly aggressive variant arising from the medulla. **High-Yield Clinical Pearls for NEET-PG:** * **Classic Triad:** Hematuria, palpable mass, and flank pain (seen in only 10% of patients). * **Paraneoplastic Syndromes:** RCC is the "great mimicker," often causing polycythemia (EPO), hypercalcemia (PTHrP), or Cushing’s (ACTH). * **Staging:** The most important prognostic factor is the **TNM stage** (specifically capsular invasion and venous involvement). * **Metastasis:** RCC has a propensity for hematogenous spread, most commonly to the **lungs** ("cannonball metastases"). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 958-961.

Q: What are the characteristic features of glomerular hematuria?

Dysmorphic red blood cells. **Explanation:** The presence of **dysmorphic red blood cells (RBCs)** in urine is the hallmark of glomerular hematuria [1]. When RBCs pass through the damaged glomerular basement membrane (GBM) and travel through the varying osmotic gradients of the renal tubules, they undergo mechanical and chemical stress [1]. This results in distorted shapes, such as blebs, protrusions, and size variations. A specific type of dysmorphic RBC, the **acanthocyte** (G1 cell), is highly predictive of glomerular disease. **Analysis of Options:** * **A. Dysmorphic RBCs (Correct):** These indicate that the source of bleeding is the glomerulus (e.g., Glomerulonephritis) [1]. * **B. Fragmented RBCs:** Also known as schistocytes, these are typically seen in the peripheral blood film in microangiopathic hemolytic anemias (MAHA) like HUS or TTP, rather than as a primary finding in urine microscopy for glomerular localization. * **C. RBCs in high-power field:** This simply defines hematuria (usually >3 RBCs/HPF) but does not differentiate between glomerular (renal) and non-glomerular (urological) sources. * **D. Gross hematuria:** This refers to visible blood in the urine. While it can occur in glomerular diseases (e.g., IgA Nephropathy), it is more commonly associated with post-renal/urological causes like stones, trauma, or malignancy [1]. **High-Yield Clinical Pearls for NEET-PG:** * **RBC Casts:** The most specific indicator of glomerular hematuria. If present, they confirm a renal parenchymal source. * **Proteinuria:** Glomerular hematuria is often associated with significant proteinuria (>500 mg/day), whereas urological hematuria is not [1]. * **Acanthocytes:** If >5% of urinary RBCs are acanthocytes, it is highly suggestive of glomerular origin. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 527-529.

Question 1

Persistent low C3 complement level is not found in which of the following conditions?

Accepted Answer

Post-streptococcal glomerulonephritis

Answer

Mesangiocapillary glomerulonephritis

Answer

Cryoglobulinemia

Answer

Systemic lupus erythematosus

Question 2

Clear cell renal cell carcinoma is most commonly associated with which genetic alteration?

Accepted Answer

3p deletion

Answer

3q deletion

Answer

6p deletion

Answer

9p deletion

Question 3

Sickle cell anemia is associated with which type of renal cell carcinoma?

Accepted Answer

Medullary

Answer

Papillary

Answer

Chromophobe

Answer

Colloid

Question 4

The intracytoplasmic vacuoles seen in the Armanni-Ebstein cell are rich in what substance?

Accepted Answer

Glycogen

Answer

Sodium and Potassium

Answer

Lipids

Answer

None of the above

Question 5

What is the most common histological variant of renal cell carcinoma (RCC)?

Accepted Answer

Clear cell

Answer

Papillary

Answer

Chromophobe

Answer

Collecting duct

Question 6

Sub-epithelial humps are characteristic of which of the following conditions?

Accepted Answer

Post-streptococcal glomerulonephritis

Answer

Minimal change glomerulonephritis

Answer

Membranous glomerulonephritis

Answer

Membranoproliferative glomerulonephritis

Question 7

Bilaterally symmetrical contracted scarred kidneys are seen in which condition?

Accepted Answer

Chronic glomerulonephritis

Answer

Nephrosclerosis

Answer

End-stage renal disease

Answer

Chronic pyelonephritis

Question 8

A 55-year-old diabetic patient with a history of renal failure awaiting transplant and undergoing hemodialysis develops amyloid deposits around the joints. What substance are these deposits likely composed of?

Accepted Answer

Beta2 microglobulin

Answer

Amyloid-associated protein

Answer

Amyloid light chains

Answer

Calcitonin precursors

Question 9

In renal disease, why does albumin appear first in the urine?

Accepted Answer

Broad cast

Answer

Hyaline cast

Answer

Coarse granular cast

Answer

Epithelial cast

Question 10

What are the characteristic features of glomerular hematuria?

Accepted Answer

Dysmorphic red blood cells

Answer

Fragmented red blood cells

Answer

Red blood cells present in a high-power field

Answer

Gross hematuria

Renal Pathology — MCQs

Renal Pathology — MCQs

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