Renal Pathology Practice Questions

Q: The important light microscopical features in Alport syndrome are all, EXCEPT:

Tubular hypertrophy. Alport Syndrome is a hereditary nephritis caused by mutations in the **COL4A3, COL4A4, or COL4A5** genes, leading to defective Type IV collagen synthesis. This primarily affects the basement membranes of the kidney, eye, and cochlea [1]. **Why "Tubular Hypertrophy" is the correct answer:** In Alport syndrome, the chronic progression of the disease leads to **tubular atrophy**, not hypertrophy [1]. As the glomeruli become sclerosed and interstitial fibrosis sets in, the associated tubules undergo degenerative changes, leading to wasting and atrophy [1]. **Analysis of Incorrect Options:** * **Glomerular changes:** Early light microscopy may be normal, but as the disease progresses, it typically shows focal segmental glomerulosclerosis (FSGS) or global sclerosis [1]. * **Segmental proliferative:** Some cases exhibit focal or diffuse mesangial proliferation or segmental proliferative glomerulonephritis before progressing to sclerosis. * **Interstitial fibrosis:** This is a hallmark of chronic renal involvement in Alport syndrome [1]. A classic light microscopic finding is the presence of **interstitial foam cells** (lipid-laden macrophages), which result from the malabsorption of tubular lipids. **High-Yield Clinical Pearls for NEET-PG:** * **Inheritance:** Most common is **X-linked Dominant** (85%). * **Electron Microscopy (Gold Standard):** Shows characteristic **"Basket-weave appearance"** due to irregular thickening, thinning, and splitting of the Glomerular Basement Membrane (GBM). * **Clinical Triad:** 1. Hereditary Nephritis (Hematuria/ESRD), 2. Sensorineural hearing loss, 3. Ocular defects (Anterior Lenticonus is pathognomonic). * **Diagnosis:** Skin biopsy can sometimes be used for diagnosis (staining for the alpha-5 chain of Type IV collagen) [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 929-930.

Q: A 45-year-old male with a history of recurrent ureteric calculi presented with fever. Following right-sided nephrectomy, gross and histological views were obtained. What is your diagnosis?

Chronic pyelonephritis with hydronephrosis. ***Chronic pyelonephritis with hydronephrosis*** - History of **recurrent ureteric calculi** leads to chronic **obstruction** causing **hydronephrosis** and subsequent chronic pyelonephritis with characteristic **thyroidization** pattern. - Gross findings show **dilated renal pelvis and calyces** with **cortical thinning**, while histology reveals **colloid-like tubular casts**, **periglomerular fibrosis**, and **chronic lymphocytic infiltrate**. *Renal cell carcinoma* - Typically presents as a **solid mass** with **clear cell** or **papillary architecture**, not as dilated collecting system with inflammatory changes. - Usually shows **hemorrhage** and **necrosis** on gross examination, lacking the **hydronephrotic** changes seen with obstruction. *Autosomal dominant polycystic kidney disease* - Characterized by **multiple large cysts** throughout both kidneys with **enlarged kidney size**, not unilateral involvement with calculi history. - Family history is usually positive and presents with **bilateral** involvement and **hypertension**, without the inflammatory thyroidization pattern. *Cystic dysplastic kidney* - A **developmental anomaly** presenting in **neonates/infants** with **primitive ducts** and **cartilage formation** on histology. - Not associated with **calculi** or **infection**, and shows **dysplastic tissue** rather than inflammatory changes and thyroidization.

Question 1

A 45-year-old man presents with hematuria. Renal biopsy demonstrates a focal necrotizing glomerulitis with crescent formation. The patient has a history of intermittent hemoptysis and intermittent chest pain of moderate intensity. A previous chest x-ray had demonstrated multiple opacities, some of which were cavitated. The patient also has chronic cold-like nasal symptoms. Which of the following is the most likely diagnosis?

Accepted Answer

Wegener's granulomatosis

Answer

Aspergillosis

Answer

Polyarteritis nodosa

Answer

Renal carcinoma metastatic to the lung

Question 2

Which of the following statements about Xanthogranulomatous pyelonephritis is not true?

Accepted Answer

Associated with tuberculosis

Answer

Foam cells are seen

Answer

Yellow nodules are seen

Answer

Giant cells may be seen

Question 3

Which of the following is a characteristic histological finding in Alport syndrome?

Accepted Answer

Thickening of the glomerular basement membrane (GBM)

Answer

Foamy cells in the interstitium

Answer

Foamy cells in tubular epithelial cells

Answer

Thinning of the glomerular basement membrane (GBM)

Question 4

The important light microscopical features in Alport syndrome are all, EXCEPT:

Accepted Answer

Tubular hypertrophy

Answer

Interstitial fibrosis

Answer

Segmental proliferative

Answer

Glomerular changes

Question 5

A 45-year-old male with a history of recurrent ureteric calculi presented with fever. Following right-sided nephrectomy, gross and histological views were obtained. What is your diagnosis?

Accepted Answer

Chronic pyelonephritis with hydronephrosis

Answer

Renal cell carcinoma

Answer

Autosomal dominant polycystic kidney disease

Answer

Cystic dysplastic kidney

Question 6

Which condition is characterized by effacement of the foot processes of the podocytes?

Accepted Answer

Minimal change disease

Answer

Focal segmental glomerulosclerosis

Answer

Acute glomerulonephritis

Answer

Membranous nephropathy

Question 7

Post-streptococcal glomerulonephritis (PSGN) is associated with which of the following?

Accepted Answer

All of the above

Answer

Subepithelial immune deposits

Answer

Nephritis along with acute renal failure

Answer

Low complement levels

Question 8

Post-infective glomerulonephritis typically presents as:

Accepted Answer

Nephritic syndrome

Answer

Acute renal failure

Answer

Nephrotic syndrome

Answer

Asymptomatic hematuria

Question 9

SUPAR is a blood marker for which of the following conditions?

Accepted Answer

Focal segmental glomerulosclerosis

Answer

Minimal change disease

Answer

Membranous nephropathy

Answer

All the above

Question 10

Which protein defect causes Finnish nephrotic syndrome?

Accepted Answer

Nephrin

Answer

Podocin

Answer

Alpha actinin

Answer

CD2 activated protein

Renal Pathology — MCQs

Renal Pathology — MCQs

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